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Wright MA, Shibata D. Addressing the Growing Challenge of Young-Onset Colorectal Cancer: The Importance of an Integrated Multidisciplinary Approach. JCO Oncol Pract 2024:OP2400527. [PMID: 39137383 DOI: 10.1200/op-24-00527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2024] [Accepted: 07/22/2024] [Indexed: 08/15/2024] Open
Abstract
Patients with young-onset colorectal cancer have unique challenges that require a multidisciplinary approach.
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Affiliation(s)
- Michael A Wright
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN
| | - David Shibata
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN
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2
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Sikorskii A, Badger T, Segrin C, Crane TE, Cunicelli N, Chalasani P, Arslan W, Given C. Predictors of persistence of post-chemotherapy symptoms among survivors of solid tumor cancers. Qual Life Res 2024; 33:1143-1155. [PMID: 38291312 DOI: 10.1007/s11136-023-03595-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2023] [Indexed: 02/01/2024]
Abstract
CONTEXT Late or residual symptoms diminish quality of life for many cancer survivors after completion of treatment. OBJECTIVES Examine risk factors associated with persisting symptom burden after chemotherapy and the lack of symptom improvement over time. METHODS Survivors who completed curative-intent chemotherapy within two years for solid tumors were enrolled into a symptom management trial. There were 375 survivors with two or more comorbid conditions or one comorbid condition and elevated depressive symptoms (pre-defined risk factors in the trial design) who received interventions and 71 survivors without these risk factors who did not receive interventions. For all survivors, symptoms were assessed at intake, 4, and 13 weeks and categorized as mild, moderate, or severe based on the interference with daily life. The probabilities of moderate or severe symptoms and symptom improvement were analyzed using generalized mixed-effects models in relation to comorbidity, depressive symptoms, age, sex, race/ethnicity, employment, time since chemotherapy completion, and physical function. Multiple symptoms were treated as nested within the survivor. RESULTS Moderate or severe symptoms at baseline and the lack of improvement over time were associated with younger age and lower physical function over and above a greater number of comorbidities and elevated severity of depressive symptoms. CONCLUSION Risk factors identified in this research (younger age, lower physical function, greater comorbidity, and higher depressive symptoms) can be used to allocate resources for post-treatment symptom management for cancer survivors in order to relieve symptoms that do not necessarily resolve with time.
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Affiliation(s)
- Alla Sikorskii
- Department of Psychiatry, College of Osteopathic Medicine, Michigan State University, 909 Wilson Road, Road 321, East Lansing, MI, 48824, USA.
| | - Terry Badger
- College of Nursing, Department of Psychiatry and Mel and Enid Zuckerman College of Public Health, University of Arizona, 1305 N. Martin Avenue, Tucson, AZ, 85721, USA
| | - Chris Segrin
- Department of Communication, University of Arizona, Tucson, USA
| | - Tracy E Crane
- Miller School of Medicine, Division of Medical Oncology, Sylvester Comprehensive Cancer Center, University of Miami, Coral Gables, USA
| | | | - Pavani Chalasani
- Division of Hematology-Oncology, George Washington University, Washington, DC, USA
| | - Waqas Arslan
- College of Medicine, University of Arizona, Phoenix, AZ, USA
| | - Charles Given
- College of Nursing, Michigan State University, East Lansing, USA
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Liu X, Jiang L, Peng X, Xu L, Huang L, Wan Q. Evaluating the effects of dyadic intervention for informal caregivers of palliative patients with lung cancer: A systematic review and meta-analysis. Int J Nurs Pract 2023. [PMID: 37963770 DOI: 10.1111/ijn.13217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 09/13/2023] [Accepted: 10/22/2023] [Indexed: 11/16/2023]
Abstract
AIM To investigate the effects of dyadic intervention on anxiety, depression, care burden and quality of life in informal caregivers of palliative patients with lung cancer. BACKGROUND Informal caregivers of palliative lung cancer patients bear a large number of negative emotions during the process of caring for the patients. Dyadic intervention has the potential for improving them but the overall effect is unclear. DESIGN A systematic review and meta-analysis. DATA SOURCES All randomized controlled trials were retrieved from the following databases until 4 May 2023: Web of Science, Embase Ovid, PubMed, Cochrane Central Register of Randomized Controlled Trials, Weipu, Wanfang and Chinese National Knowledge Infrastructure databases. REVIEW METHODS This review was performed by Stata 12.0 and Review Manager 5.3. RESULTS Thirteen randomized controlled trials were in accordance with the inclusion and exclusion criteria (n = 1807). The results revealed that dyadic intervention significantly improved family caregivers' anxiety, depression and caregiver burden of palliative patients with lung cancer. There was no significant difference in quality of life between the dyadic intervention group and family caregivers who did not receive the dyadic intervention. CONCLUSIONS Dyadic intervention positively impacts the experience of family caregivers of palliative patients with lung cancer.
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Affiliation(s)
- Xin Liu
- Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China
| | - Li Jiang
- Department of Respiratory and Critical Care Medicine, Huaxi Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Xi Peng
- Department of Respiratory and Critical Care Medicine, Huaxi Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Ling Xu
- Department of Respiratory and Critical Care Medicine, Huaxi Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Lingling Huang
- Department of Respiratory and Critical Care Medicine, Huaxi Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Qunfang Wan
- Department of Respiratory and Critical Care Medicine, Huaxi Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
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Harper A, Maseja N, Parkinson R, Pakseresht M, McKillop S, Henning JW, Watson L, Cuthbert C, Cheung W, Fidler-Benaoudia MM. Symptom severity and trajectories among adolescent and young adult patients with cancer. JNCI Cancer Spectr 2023; 7:pkad049. [PMID: 37943323 PMCID: PMC10634503 DOI: 10.1093/jncics/pkad049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/28/2023] [Accepted: 07/18/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Patients with cancer experience significant symptom burden. We investigated symptom severity in adolescents and young adults (18- to 39-year-olds) during the year following a cancer diagnosis and made comparisons with older adult (those older than 40 years of age) patients with cancer. METHODS All Albertan residents diagnosed with a first primary neoplasm at 18 years of age or older between April 1, 2018, and December 31, 2019, and who completed at least 1 electronic patient-reported outcome questionnaire were included. Symptom severity was assessed using the Edmonton Symptom Assessment System-revised. Descriptive statistics, multivariable logistic modeling, and mixed logistic regression modeling were used to describe symptom severity, identify risk factors, and assess symptom trajectories, respectively. RESULTS In total, 473 and 322 adolescents and young adults completed a patient-reported outcomes questionnaire at diagnosis and 1 year after diagnosis, respectively. Adolescent and young adult patients with cancer reported high levels of tiredness, poor well-being, and anxiety. Important risk factors included metastatic disease, female sex, treatment types received, and age at diagnosis. Symptom severity varied by clinical tumor group, with those diagnosed with sarcoma having the worst scores for all symptoms at diagnosis and patients with intrathoracic or endocrine tumors having the worst scores for all symptoms at 1 year after diagnosis. Statistically significant differences in symptom severity over the 1-year period were observed between adolescents and young adults and older adults-specifically, the odds of having moderate to severe symptoms were statistically significantly greater among adolescents and young adults with respect to pain, tiredness, nausea, depression, anxiety, and poor well-being (all P < .01). CONCLUSIONS A substantial proportion of adolescents and young adults experience moderate to severe symptoms during the year following diagnosis. Modifying existing supportive services and developing interventions based on the needs of adolescent and young adult patients with cancer could aid symptom control.
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Affiliation(s)
- Andrew Harper
- Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Calgary, AB, Canada
| | - Nicole Maseja
- Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Reilly Parkinson
- Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Calgary, AB, Canada
| | - Mohammadreza Pakseresht
- Surveillance and Reporting, Cancer Research and Analytics, Cancer Care Alberta, Alberta Health Services, Edmonton, AB, Canada
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB, Canada
| | - Sarah McKillop
- Division of Hematology/Oncology, Stollery Children’s Hospital, Edmonton, AB, Canada
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Jan-Willem Henning
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Linda Watson
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
- Applied Research and Patient Experience, Cancer Care Alberta, Alberta Health Services, Calgary, AB, Canada
| | - Colleen Cuthbert
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
| | - Winson Cheung
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Miranda M Fidler-Benaoudia
- Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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5
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DSilva F, Singh P, Javeth A. Determinants of Cancer-Related Fatigue among Cancer Patients: A Systematic Review. J Palliat Care 2023; 38:432-455. [PMID: 36245333 DOI: 10.1177/08258597221131133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: This systematic review aims to assess and explore various determinants of cancer- related fatigue. Methods: A systematic search of various determinants of Cancer-related fatigue (CRF) was performed in different databases like PubMed, Google Scholar, Science Direct and Clinical Key dating from 1990 to September 2020. Results: A total of 6115 studies were screened and 95 articles related to determinants of fatigue were retained. Various modifiable and non-modifiable determinants including socio-demographic, clinical, treatment related, plasma biomarker related, genetic, behavioural, concurrent symptoms related and psychological determinants were identified. Depression was one of the significant factors reported in 28% of studies, followed by pain, (17%), performance status (16%), chemotherapy and anxiety (15%). Conclusion: It is recommended that nurses and clinicians should anticipate, identify and take appropriate interventions to manage those modifiable factors. Ultimately, managing the modifiable factors helps in the comprehensive care of cancer patients.
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Affiliation(s)
- Fatima DSilva
- Nitte Usha Institute of Nursing Sciences, Nitte University, Mangalore, Karnataka, India
| | - Pritanjali Singh
- Department of Radiation Oncology, All India Institute of Medical Science (AIIMS), Patna, Bihar, India
| | - Athar Javeth
- College of Nursing, All India Institute of Medical Science (AIIMS), Patna, Bihar, India
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Arana-Chicas E, Prisco LMH, Sharma S, Stauffer F, McGee M, Dauphin S, Ban-Hoefen M, Navarette J, Zittel J, Cupertino AP, Magnuson A, Mustian KM, Mohile SG. Cancer survivorship challenges of rural older adults: a qualitative study. BMC Cancer 2023; 23:917. [PMID: 37770838 PMCID: PMC10536752 DOI: 10.1186/s12885-023-11395-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 09/11/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Although research has advanced the field of oncologic geriatrics with survivors to assess their cancer-related needs and devise patient-centered interventions, most of that research has excluded rural populations. This study aimed to understand the survivorship challenges and recommendations in the perspective of rural older adults. METHODS This was a qualitative study that explored the survivorship challenges and recommendations of rural older adults who have completed curative intent chemotherapy for a solid tumor malignancy in the 12 months prior to enrollment in the present study. RESULTS Twenty-seven older adult survivors from rural areas completed open-ended semi-structured interviews. The mean age was 73.4 (SD = 5.0). Most participants were non-Hispanic White (96.3%), female (59.3%), married (63.0%), and had up to a high school education (51.9%). Rural older survivors reported a general lack of awareness of survivorship care plans, communication challenges with healthcare team, transportation challenges, financial toxicity, psychological challenges, and diet and physical challenges. Rural older survivors recommend the provision of nutritional advice referral to exercise programs, and social support groups and for their healthcare providers to discuss their survivorship plan with them. CONCLUSIONS Although study participants reported similar survivorship challenges as urban older adult survivors, additional challenges reported regarding transportation and consideration of farm animals have not been previously reported. Heightened awareness of the survivorship needs of rural older adults may result in better survivorship care for this population.
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Affiliation(s)
- Evelyn Arana-Chicas
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA.
- Division of Supportive Care in Cancer, Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA.
- Geriatric Oncology Research Group, University of Rochester Medical Center, Rochester, NY, USA.
| | - Laura M Hincapie Prisco
- Geriatric Oncology Research Group, University of Rochester Medical Center, Rochester, NY, USA
| | - Saloni Sharma
- Geriatric Oncology Research Group, University of Rochester Medical Center, Rochester, NY, USA
| | - Fiona Stauffer
- Geriatric Oncology Research Group, University of Rochester Medical Center, Rochester, NY, USA
| | - Martha McGee
- Specialized Oncology Care & Research for our Elders Board Patient and Caregiver Advocate Board (SOCAREboard), University of Rochester Medical Center, Rochester, NY, USA
| | | | - Makiko Ban-Hoefen
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
| | | | - Jason Zittel
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
| | - Ana Paula Cupertino
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
- Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Allison Magnuson
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
- Geriatric Oncology Research Group, University of Rochester Medical Center, Rochester, NY, USA
- Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, New York, USA
| | - Karen M Mustian
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
- Division of Supportive Care in Cancer, Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
- Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Supriya G Mohile
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
- Geriatric Oncology Research Group, University of Rochester Medical Center, Rochester, NY, USA
- Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, New York, USA
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Shah K, Geller DA, Tohme S, Antoni M, Kallem CJ, Vodovotz Y, Ramanathan R, Naveen R, Geroni M, Devine L, Amin A, Kiefer GJ, Zandberg DP, Reyes V, Steel JL. Predictors and Consequences of Cancer and Non-Cancer-Related Pain in Those Diagnosed with Primary and Metastatic Cancers. Curr Oncol 2023; 30:8826-8840. [PMID: 37887537 PMCID: PMC10605887 DOI: 10.3390/curroncol30100637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 09/08/2023] [Accepted: 09/20/2023] [Indexed: 10/28/2023] Open
Abstract
OBJECTIVES The aims of the study were to (1) describe types of pain in cancer patients, (2) examine the predictors and consequences of pain, (3) investigate the association between type of pain and survival, and (4) examine potential biological mediators of pain and survival. METHODS This was a secondary analysis of baseline data from patients diagnosed with cancer. Patients answered questionnaires that assessed sociodemographic characteristics, pain, depression, sleep, and fatigue. Blood was collected and cytokine assays were performed. Analysis of variance, Kaplan-Meier, and Cox regression survival analyses were used to test the aims. RESULTS Of the 779 patients diagnosed with cancer, the mean age was 63.5 years, 57.8% male, and 90.6% White. Of those who reported pain (total 70.3%), 46.5% stated their pain was cancer-related while 53.5% stated their pain was non-cancer-related. While both cancer and non-cancer-related pain was associated with depressive symptoms, fatigue, and sleep duration, those with cancer-related pain had significantly higher rates of depressive symptoms (F(1,516) = 21.217, p < 0.001) and fatigue (F(1,516) = 30.973, p < 0.001) but not poorer sleep (F(1,497) = 0.597, p = 0.440). After adjusting for sociodemographic, disease-related characteristics, depression, sleep duration, and morphine milligram equivalent, patient reports of cancer-related pain were significantly associated with poorer survival (HR = 0.646, 95% CI = 0.459-0.910, p = 0.012) compared to those with non-cancer-related pain, which was not associated with survival (HR = 1.022, 95% CI = 0.737-1.418, p = 0.896). Cytokines did not significantly mediate the link between pain and survival. CONCLUSION While nearly half of the pain reported was cancer-related, both types of pain resulted in greater symptom burden, but only cancer-related pain was associated with survival.
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Affiliation(s)
- Kriti Shah
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA 15213, USA; (K.S.); (D.A.G.); (S.T.); (C.J.K.); (Y.V.); (R.R.); (R.N.); (M.G.); (L.D.); (A.A.)
| | - David A. Geller
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA 15213, USA; (K.S.); (D.A.G.); (S.T.); (C.J.K.); (Y.V.); (R.R.); (R.N.); (M.G.); (L.D.); (A.A.)
| | - Samer Tohme
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA 15213, USA; (K.S.); (D.A.G.); (S.T.); (C.J.K.); (Y.V.); (R.R.); (R.N.); (M.G.); (L.D.); (A.A.)
| | - Michael Antoni
- Department of Psychology, University of Miami, Coral Gables, FL 33124, USA;
| | - Cramer J. Kallem
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA 15213, USA; (K.S.); (D.A.G.); (S.T.); (C.J.K.); (Y.V.); (R.R.); (R.N.); (M.G.); (L.D.); (A.A.)
| | - Yoram Vodovotz
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA 15213, USA; (K.S.); (D.A.G.); (S.T.); (C.J.K.); (Y.V.); (R.R.); (R.N.); (M.G.); (L.D.); (A.A.)
| | - Rekha Ramanathan
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA 15213, USA; (K.S.); (D.A.G.); (S.T.); (C.J.K.); (Y.V.); (R.R.); (R.N.); (M.G.); (L.D.); (A.A.)
| | - Raam Naveen
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA 15213, USA; (K.S.); (D.A.G.); (S.T.); (C.J.K.); (Y.V.); (R.R.); (R.N.); (M.G.); (L.D.); (A.A.)
| | - MacKenzie Geroni
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA 15213, USA; (K.S.); (D.A.G.); (S.T.); (C.J.K.); (Y.V.); (R.R.); (R.N.); (M.G.); (L.D.); (A.A.)
| | - LaNita Devine
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA 15213, USA; (K.S.); (D.A.G.); (S.T.); (C.J.K.); (Y.V.); (R.R.); (R.N.); (M.G.); (L.D.); (A.A.)
| | - Aarshati Amin
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA 15213, USA; (K.S.); (D.A.G.); (S.T.); (C.J.K.); (Y.V.); (R.R.); (R.N.); (M.G.); (L.D.); (A.A.)
| | - Gauri J. Kiefer
- UPMC Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA; (G.J.K.); (D.P.Z.); (V.R.)
| | - Dan P. Zandberg
- UPMC Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA; (G.J.K.); (D.P.Z.); (V.R.)
| | - Vincent Reyes
- UPMC Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA; (G.J.K.); (D.P.Z.); (V.R.)
| | - Jennifer L. Steel
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA 15213, USA; (K.S.); (D.A.G.); (S.T.); (C.J.K.); (Y.V.); (R.R.); (R.N.); (M.G.); (L.D.); (A.A.)
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Ahmed KA, Mahmoud A, Mohammed KA, Ibrahim BR. Role of interventional radiology in upper abdominal cancer pain management. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2023. [DOI: 10.1186/s43055-023-01006-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
Abstract
Background
The major indication for celiac plexus block is abdominal pain that is nonresponsive to analgesic interventions; often these patients are nonresponsive to high-dose opioid therapies. One of the most common indications for the celiac plexus block is the treatment of abdominal pain associated with pancreatic cancer.
Aim of the work
The differences between two techniques (ultrasound and fluoroscopy guided) are highlighted in terms of effectiveness by means of a Visual Analog Scale (VAS), a percentage reduction in daily morphine consumption and any complications are recorded and evaluated at the time of implementation of each technique from start to finish.
Results
Through the data that have been recorded and statistically analyzed, we found that the mean values of VAS were decreased in the two groups, and there was statistically significant difference between ultrasound and fluoroscopy groups.
Conclusions
It is noticeable and good in conducting this research that there are no major complications that include a large space on the study sample, despite the presence of some minor with no significant differences between ultrasound and fluoroscopy groups. This effective celiac block, regardless of the technique used, produced immediate analgesics that permitted significant opioid decrease in the study sample with a significant improvement in the unwanted adverse effects on account of opioids.
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Gupta S, Li Q, Nathan PC, D'Agostino N, Baxter NN, Fox C, Chalifour K, Coburn N, Sutradhar R. Prevalence, severity, and predictors of symptom burden among adolescents and young adults with cancer. Cancer Med 2023. [DOI: 10.1002/cam4.5837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 02/23/2023] [Accepted: 03/12/2023] [Indexed: 03/29/2023] Open
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10
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Sherief ST, Girma E, Wu F, O'Banion J, Wondimagegn D, Teshome T, Dimaras H. Caring for a child with retinoblastoma: Experience of Ethiopian parents. Pediatr Blood Cancer 2023; 70:e30163. [PMID: 36545916 DOI: 10.1002/pbc.30163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 11/05/2022] [Accepted: 11/28/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE This study explored the lived experience of parents of children with retinoblastoma. DESIGN AND METHOD A phenomenological qualitative study design was used, and a purposive sampling technique to recruit parents of children with retinoblastoma. Semi-structured interviews were conducted to document the lived experience of participants, who were asked to narrate their experiences caring for a child with retinoblastoma, thinking back to the day they learned about their child's condition, as well as their thoughts about the future. The interviews were conducted in Amharic and Oromo language, and audio recordings were transcribed and translated to English. Data were analyzed using thematic analysis. RESULTS Thirteen parents (seven mothers, six fathers) participated in the study. Collectively, the children of the participants represented all the stages of the retinoblastoma journey (i.e., diagnosis, treatment, remission, and recurrence). Five major themes emerged from the thematic data analysis: (a) reactions when learning the child's condition; (b) receiving health care; (c) costs of caregiving; (d) support; and (e) uncertainties. CONCLUSION The lived experiences of parents of children with retinoblastoma revealed a significant mental health and psychosocial burden. The sources of mental distress were found to be complex and varied. Holistic care for retinoblastoma should include programs that address the biopsychosocial needs of caregivers.
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Affiliation(s)
- Sadik Taju Sherief
- Department of Ophthalmology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Engida Girma
- Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia
| | - Fran Wu
- Department of Ophthalmology, Emory University, Atlanta, Georgia, USA
| | | | - Dawit Wondimagegn
- Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tiliksew Teshome
- Department of Ophthalmology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Helen Dimaras
- Department of Ophthalmology and Vision Science, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.,Child Health Evaluative Sciences Program and Centre for Global Child Health, SickKids Research Institute, Toronto, Ontario, Canada.,Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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11
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Harris CS, Dodd M, Kober KM, Dhruva AA, Hammer M, Conley YP, Miaskowski CA. Advances in Conceptual and Methodological Issues in Symptom Cluster Research: A 20-Year Perspective. ANS Adv Nurs Sci 2022; 45:309-322. [PMID: 35502915 PMCID: PMC9616968 DOI: 10.1097/ans.0000000000000423] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Two conceptual approaches are used to evaluate symptom clusters: "clustering" symptoms (ie, variable-centered analytic approach) and "clustering" patients (ie, person-centered analytic approach). However, these methods are not used consistently and conceptual clarity is needed. Given the emergence of novel methods to evaluate symptom clusters, a review of the conceptual basis for older and newer analytic methods is warranted. Therefore, this article will review the conceptual basis for symptom cluster research; compare and contrast the conceptual basis for using variable-centered versus patient-centered analytic approaches in symptom cluster research; review their strengths and weaknesses; and compare their applications in symptom cluster research.
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Affiliation(s)
| | - Marylin Dodd
- School of Nursing, University of California, San Francisco, CA, USA
| | - Kord M. Kober
- School of Nursing, University of California, San Francisco, CA, USA
| | - Anand A. Dhruva
- School of Medicine, University of California, San Francisco, CA, USA
| | | | - Yvette P. Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Christine A. Miaskowski
- School of Nursing, University of California, San Francisco, CA, USA
- School of Medicine, University of California, San Francisco, CA, USA
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12
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Barrera-Caballero S, Romero-Moreno R, Vara-García C, Márquez-González M, Olazarán J, Losada-Baltar A. Cognitive fusion and distress in family caregivers: the role of satisfaction with personal values. Aging Ment Health 2022:1-6. [PMID: 36165229 DOI: 10.1080/13607863.2022.2126432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Objectives: cognitive fusion (the tendency towards behavior that is overly regulated and influenced by cognition) and dissatisfaction with personal values are central processes of psychological inflexibility and are related to distress. Being cognitively fused may interfere with achieving satisfaction from personal values. This study analyzed the role of satisfaction with the value of caregiving and other personal values (e.g. personal growth) in the relationship between cognitive fusion and caregivers' distress.Method: a total of 287 dementia family caregivers participated in this quantitative study carried out in Madrid, Spain, from January 2016 to February 2020. We measured sociodemographic and stressor variables, cognitive fusion, caregivers' satisfaction with values and depressive and anxiety symptoms. The indirect effect of cognitive fusion on distress through caregivers' satisfaction with caregiving value and with other personal values was tested. Four hierarchical regression models were analyzed: the role of satisfaction with the caregiving value in the association between cognitive fusion and depressive (Model 1a) and anxiety (Model 1b) symptoms; and the role of satisfaction with other personal values in the association between cognitive fusion and depressive (Model 2a) and anxiety (Model 2b) symptoms.Results: the results showed an indirect effect of cognitive fusion on both depressive and anxiety symptoms only through satisfaction with other personal values. Those reporting higher cognitive fusion reported lower satisfaction with other personal values, and this association was related to higher scores in depressive and anxiety symptoms (Models 2a and 2b).Conclusion: cognitive fusion could be a variable that interferes in obtaining satisfaction from personal values, something that increases caregivers' distress.
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Affiliation(s)
| | - Rosa Romero-Moreno
- Department of Psychology, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Carlos Vara-García
- Department of Psychology, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - María Márquez-González
- Department of Biological and Health Psychology, Universidad Autónoma de Madrid, Madrid, Spain
| | - Javier Olazarán
- Service of Neurology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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13
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Wallström S, Sutherland JM, Kopec JA, Anis AH, Sawatzky R. Distinguishing symptom patterns in adults newly diagnosed with cancer: a latent class analysis. J Pain Symptom Manage 2022; 64:146-155. [PMID: 35460831 DOI: 10.1016/j.jpainsymman.2022.04.172] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 04/05/2022] [Accepted: 04/11/2022] [Indexed: 11/19/2022]
Abstract
CONTEXT Socio-demographic differences, including place of residence, socio-economic status, ethnicity, and gender, have been associated with various inequities in cancer care outcomes. OBJECTIVES The aims were to distinguish subgroups of patients with different symptom patterns at the time of the initial oncology visit and determine which clinical and socio-demographic variables are associated the different symptom patterns. METHOD Responses to the Edmonton Symptom Assessment Scale- revised and clinical and socio-demographic variables were obtained via the Ontario Cancer Registry and linked health data files. Latent class analyses were conducted to identify and compare the subgroups. RESULTS The cohort (n = 216,110) with a mean age of 64.5 years consisted of 54.1% women. The analyses identified six latent classes (proportions ranging from 0.09 to 0.31) with distinct symptom patterns, including: 1) many severe symptoms, 2) many less severe symptoms, 3) predominantly mild symptoms, 4) severe psychosocial symptoms, 5) severe somatic symptoms, 6) few symptoms. The subgroups were associated not only with clinical differences (diagnoses and functional status), but also with various socio-demographic (age, sex) and community characteristics (neighborhood income, proportion of foreign born, rurality). CONCLUSION The results indicated that there were substantial differences in symptom patterns at the time of the initial oncology visit, which were associated with both clinical diagnoses and socio-demographic differences. These results point to the importance of taking the social situation of patients into account, and not just diagnosis, to better understand differences in symptom patterns of people living with cancer.
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Affiliation(s)
- Sara Wallström
- Institute of Health and Care Sciences (S.W., R.S.), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Center for Person-Centered Care (GPCC) (S.W.), University of Gothenburg, Gothenburg, Sweden; Forensic Psychiatric Clinic (S.W.), Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jason M Sutherland
- Center for Health Services and Policy Research (J.M.S.), School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada; School of Population and Public Health (J.M.S., J.A.K., A.H.A.), University of British Columbia, Vancouver, BC, Canada; Center for Health Evaluation and Outcome Sciences (J.M.S., R.S.), Vancouver, BC, Canada
| | - Jacek A Kopec
- Arthritis Research Canada (J.A.K.), Vancouver, BC, Canada; School of Population and Public Health (J.M.S., J.A.K., A.H.A.), University of British Columbia, Vancouver, BC, Canada
| | - Aslam H Anis
- School of Population and Public Health (J.M.S., J.A.K., A.H.A.), University of British Columbia, Vancouver, BC, Canada; Center for Health Evaluation and Outcome Sciences (J.M.S., R.S.), Vancouver, BC, Canada
| | - Richard Sawatzky
- Institute of Health and Care Sciences (S.W., R.S.), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Center for Health Evaluation and Outcome Sciences (J.M.S., R.S.), Vancouver, BC, Canada; School of Nursing (R.S.), Trinity Western University, Langley, BC, Canada.
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14
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Harris CS, Kober KM, Cooper B, Conley YP, Dhruva AA, Hammer MJ, Paul S, Levine JD, Miaskowski CA. Symptom clusters in outpatients with cancer using different dimensions of the symptom experience. Support Care Cancer 2022; 30:6889-6899. [PMID: 35543816 PMCID: PMC10792845 DOI: 10.1007/s00520-022-07125-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 05/05/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE Relatively few studies have evaluated for symptom clusters across multiple dimensions. It is unknown whether the symptom dimension used to create symptom clusters influences the number and types of clusters that are identified. Study purposes were to describe ratings of occurrence, severity, and distress for 38 symptoms in a heterogeneous sample of oncology patients (n = 1329) undergoing chemotherapy; identify and compare the number and types of symptom clusters based on three dimensions (i.e., occurrence, severity, and distress); and identify common and distinct clusters. METHODS A modified version of the Memorial Symptom Assessment Scale was used to assess the occurrence, severity, and distress ratings of 38 symptoms in the week prior to patients' next cycle of chemotherapy. Symptom clusters for each dimension were identified using exploratory factor analysis. RESULTS Patients reported an average of 13.9 (±7.2) concurrent symptoms. Lack of energy was both the most common and severe symptom while "I don't look like myself" was the most distressing. Psychological, gastrointestinal, weight gain, respiratory, and hormonal clusters were identified across all three dimensions. Findings suggest that psychological, gastrointestinal, and weight gain clusters are common while respiratory and hormonal clusters are distinct. CONCLUSIONS Psychological, gastrointestinal, weight gain, hormonal, and respiratory clusters are stable across occurrence, severity, and distress in oncology patients receiving chemotherapy. Given the stability of these clusters and the consistency of the symptoms across dimensions, the use of a single dimension to identify these clusters may be sufficient. However, comprehensive and disease-specific inventories need to be used to identify distinct clusters.
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Affiliation(s)
- Carolyn S Harris
- School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA, 94143-0610, USA
| | - Kord M Kober
- School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA, 94143-0610, USA
| | - Bruce Cooper
- School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA, 94143-0610, USA
| | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Anand A Dhruva
- School of Medicine, University of California, San Francisco, CA, USA
| | | | - Steven Paul
- School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA, 94143-0610, USA
| | - Jon D Levine
- School of Medicine, University of California, San Francisco, CA, USA
| | - Christine A Miaskowski
- School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA, 94143-0610, USA.
- School of Medicine, University of California, San Francisco, CA, USA.
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15
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Rock CL, Thomson CA, Sullivan KR, Howe CL, Kushi LH, Caan BJ, Neuhouser ML, Bandera EV, Wang Y, Robien K, Basen-Engquist KM, Brown JC, Courneya KS, Crane TE, Garcia DO, Grant BL, Hamilton KK, Hartman SJ, Kenfield SA, Martinez ME, Meyerhardt JA, Nekhlyudov L, Overholser L, Patel AV, Pinto BM, Platek ME, Rees-Punia E, Spees CK, Gapstur SM, McCullough ML. American Cancer Society nutrition and physical activity guideline for cancer survivors. CA Cancer J Clin 2022; 72:230-262. [PMID: 35294043 DOI: 10.3322/caac.21719] [Citation(s) in RCA: 247] [Impact Index Per Article: 123.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/22/2021] [Accepted: 12/15/2021] [Indexed: 12/13/2022] Open
Abstract
The overall 5-year relative survival rate for all cancers combined is now 68%, and there are over 16.9 million survivors in the United States. Evidence from laboratory and observational studies suggests that factors such as diet, physical activity, and obesity may affect risk for recurrence and overall survival after a cancer diagnosis. The purpose of this American Cancer Society guideline is to provide evidence-based, cancer-specific recommendations for anthropometric parameters, physical activity, diet, and alcohol intake for reducing recurrence and cancer-specific and overall mortality. The audiences for this guideline are health care providers caring for cancer survivors as well as cancer survivors and their families. The guideline is intended to serve as a resource for informing American Cancer Society programs, health policy, and the media. Sources of evidence that form the basis of this guideline are systematic literature reviews, meta-analyses, pooled analyses of cohort studies, and large randomized clinical trials published since 2012. Recommendations for nutrition and physical activity during cancer treatment, informed by current practice, large cancer care organizations, and reviews of other expert bodies, are also presented. To provide additional context for the guidelines, the authors also include information on the relationship between health-related behaviors and comorbidities, long-term sequelae and patient-reported outcomes, and health disparities, with attention to enabling survivors' ability to adhere to recommendations. Approaches to meet survivors' needs are addressed as well as clinical care coordination and resources for nutrition and physical activity counseling after a cancer diagnosis.
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Affiliation(s)
- Cheryl L Rock
- Department of Family Medicine, School of Medicine, University of California at San Diego, La Jolla, California
| | - Cynthia A Thomson
- Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | - Kristen R Sullivan
- Department of Population Sciences, American Cancer Society, Atlanta, Georgia
| | - Carol L Howe
- Department of Medicine, University of Arizona Health Sciences Library, Tucson, Arizona
- Department of Family and Community Medicine, University of Arizona Health Sciences Library, Tucson, Arizona
| | - Lawrence H Kushi
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Bette J Caan
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Marian L Neuhouser
- Cancer Prevention Program, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Elisa V Bandera
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Ying Wang
- Department of Population Sciences, American Cancer Society, Atlanta, Georgia
| | - Kimberly Robien
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia
| | - Karen M Basen-Engquist
- Division of Cancer Prevention and Population Sciences, Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Justin C Brown
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, Louisiana
| | - Kerry S Courneya
- Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Tracy E Crane
- Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
- Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Coral Gables, Florida
| | - David O Garcia
- Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | - Barbara L Grant
- Cancer Care Center, St Alphonsus Regional Medical Center, Boise, Idaho
| | - Kathryn K Hamilton
- Carol G. Simon Cancer Center, Morristown Medical Center, Morristown, New Jersey
| | - Sheri J Hartman
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California at San Diego, La Jolla, California
| | - Stacey A Kenfield
- Department of Urology, University of California at San Francisco, San Francisco, California
| | - Maria Elena Martinez
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California at San Diego, La Jolla, California
- Moores Cancer Center, University of California at San Diego, La Jolla, California
| | | | - Larissa Nekhlyudov
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Alpa V Patel
- Department of Population Sciences, American Cancer Society, Atlanta, Georgia
| | - Bernardine M Pinto
- College of Nursing, University of South Carolina, Columbia, South Carolina
| | - Mary E Platek
- School of Health Professions, D'Youville College, Buffalo, New York
- Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Erika Rees-Punia
- Department of Population Sciences, American Cancer Society, Atlanta, Georgia
| | - Colleen K Spees
- College of Medicine, The Ohio State University, Columbus, Ohio
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16
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Kogan LR, Wallace JE, Hellyer PW, Carr ECJ. Canine Caregivers: Paradoxical Challenges and Rewards. Animals (Basel) 2022; 12:ani12091074. [PMID: 35565501 PMCID: PMC9099636 DOI: 10.3390/ani12091074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/15/2022] [Accepted: 04/17/2022] [Indexed: 01/02/2023] Open
Abstract
Companion dogs are increasingly popular, 38.4% of households in the United States include at least one dog. There are numerous benefits to sharing one’s home with a dog, but because they age more rapidly than people and have shorter lifespans, acquiring a dog often includes caring for it during its senior years. Caring for an elderly dog can be physically and emotionally challenging, yet the impact on guardians’ lives when caring for an aging dog has received minimal scientific attention. This study was designed to better understand dog guardians’ experiences and perceptions related to caring for their aging dog. Utilizing an exploratory mixed methods design, this study asked dog guardians to complete an online anonymous survey. From a total of 284 participants, we found that the impact on guardians when caring for an aging dog appears to share many similarities with caregivers of human family members. Our quantitative and qualitative results suggest that, for many guardians, caring for an aging dog is a complex dynamic with both positive and negative factors that offers an opportunity to deepen the human-animal bond and create positive, rewarding experiences and memories.
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Affiliation(s)
- Lori R. Kogan
- College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO 80523, USA;
- Correspondence:
| | - Jean E. Wallace
- Department of Sociology, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada;
| | - Peter W. Hellyer
- College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO 80523, USA;
| | - Eloise C. J. Carr
- Emeritus, Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada;
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17
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Natsume K, Sakakima H, Kawamura K, Yoshida A, Akihiro S, Yonezawa H, Yoshimoto K, Shimodozono M. Factors Influencing the Improvement of Activities of Daily Living during Inpatient Rehabilitation in Newly Diagnosed Patients with Glioblastoma Multiforme. J Clin Med 2022; 11:jcm11020417. [PMID: 35054111 PMCID: PMC8780839 DOI: 10.3390/jcm11020417] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/12/2022] [Accepted: 01/13/2022] [Indexed: 12/01/2022] Open
Abstract
Glioblastoma multiforme (GBM) is the most common and aggressive brain tumor. To identify the factors influencing the improvement of the activities of daily living (ADL) in newly diagnosed patients with GBM, we investigated the characteristics and variable factors and overall survival. A total of 105 patients with GBM were retrospectively analyzed and categorized into the following three groups according to the quartile of change of their Barthel index score from admission to discharge: deterioration (n = 25), no remarkable change (n = 55), and good recovery (n = 25). A statistical difference was observed in the pre-operative, intra-operative, post-operative, and rehabilitation-related factors between the deterioration and good recovery groups. Multiple regression analysis identified the following significant factors that may influence the improvement of ADL after surgery: the improvement of motor paralysis after surgery, mild fatigue during radio and chemotherapy, and length up to early walking training onset. The median overall survival was significantly different between the deterioration (10.6 months) and good recovery groups (18.9 months, p = 0.025). Our findings identified several factors that may be associated with post-operative functional improvement in patients with GBM. The inpatient rehabilitation during radio and chemotherapy may be encouraged without severe adverse events and can promote functional outcomes, which may contribute to the overall survival of newly diagnosed patients with GBM.
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Affiliation(s)
- Keisuke Natsume
- Division of Rehabilitation, Kagoshima University Hospital, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan; (K.N.); (K.K.); (A.Y.); (S.A.); (M.S.)
- Department of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, Kagoshima 890-8544, Japan
| | - Harutoshi Sakakima
- Department of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, Kagoshima 890-8544, Japan
- Correspondence: ; Tel.: +81-99-275-6778; Fax: +81-99-275-6804
| | - Kentaro Kawamura
- Division of Rehabilitation, Kagoshima University Hospital, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan; (K.N.); (K.K.); (A.Y.); (S.A.); (M.S.)
| | - Akira Yoshida
- Division of Rehabilitation, Kagoshima University Hospital, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan; (K.N.); (K.K.); (A.Y.); (S.A.); (M.S.)
- Department of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, Kagoshima 890-8544, Japan
| | - Shintaro Akihiro
- Division of Rehabilitation, Kagoshima University Hospital, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan; (K.N.); (K.K.); (A.Y.); (S.A.); (M.S.)
| | - Hajime Yonezawa
- Department of Neurosurgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima 890-8544, Japan; (H.Y.); (K.Y.)
| | - Koji Yoshimoto
- Department of Neurosurgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima 890-8544, Japan; (H.Y.); (K.Y.)
| | - Megumi Shimodozono
- Division of Rehabilitation, Kagoshima University Hospital, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan; (K.N.); (K.K.); (A.Y.); (S.A.); (M.S.)
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18
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Gupta S, Sutradhar R, Li Q, Coburn N. The effectiveness of a provincial symptom assessment program in reaching adolescents and young adults with cancer: A population-based cohort study. Cancer Med 2021; 10:9030-9039. [PMID: 34738747 PMCID: PMC8683532 DOI: 10.1002/cam4.4401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 09/12/2021] [Accepted: 10/24/2021] [Indexed: 11/21/2022] Open
Abstract
Background Symptom control is prioritized by cancer patients and may improve overall survival. Ontario, Canada thus offers all cancer patients screening using the Edmonton Symptom Assessment System (ESAS) at outpatient cancer‐related visits. We determined whether this initiative reached adolescents and young adults (AYA) and factors associated with screening in this population. Methods We linked all Ontario AYA diagnosed with cancer 2010–2018 aged 15–29 years to population‐based databases identifying outpatient visits and ESAS screening. For each 2‐week period in the year post‐diagnosis, AYA with cancer‐related visits were categorized as “unscreened” (no ESAS score) versus “screened” (≥1 ESAS score). Demographic and disease‐related covariates were examined. Results Among 5435 AYA, 4204 (77.4%) had ≥1 ESAS screen. Within any 2‐week period, only 30%–44% of AYA attending cancer‐related visits were screened. Patients with hematologic malignancies were least likely to be screened [odds ratio (OR) vs. breast cancer 0.77, 95% confidence interval (95% CI) 0.67–0.88; p < 0.001]. AYA in remote Northern or rural areas had equivalent or higher rates of ESAS screening compared to those in high‐income urban areas. However, AYA living in the lowest income urban neighborhoods were less likely to be screened (OR 0.86, 95% CI 0.77–0.97; p = 0.01). Conclusions Within a population‐wide symptom assessment program, while AYA living in rural and remote areas had high rates of screening, than those in low‐income urban areas were substantially less likely to be screened. Though patients with hematologic cancers suffer from particularly high symptom burdens, they were also less likely to be screened. Interventions targeting AYA are required to increase uptake.
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Affiliation(s)
- Sumit Gupta
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada.,Cancer Research Program, ICES, Toronto, Canada.,Institute for Health Policy, Evaluation and Management, University of Toronto, Toronto, Canada.,Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Rinku Sutradhar
- Cancer Research Program, ICES, Toronto, Canada.,Institute for Health Policy, Evaluation and Management, University of Toronto, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Qing Li
- Cancer Research Program, ICES, Toronto, Canada
| | - Natalie Coburn
- Cancer Research Program, ICES, Toronto, Canada.,Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Canada.,Department of Surgery, University of Toronto, Toronto, Canada.,Sunnybrook Research Institute, Toronto, Canada
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19
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Applebaum AJ, Panjwani AA, Buda K, O'Toole MS, Hoyt MA, Garcia A, Fresco DM, Mennin DS. Emotion regulation therapy for cancer caregivers-an open trial of a mechanism-targeted approach to addressing caregiver distress. Transl Behav Med 2021; 10:413-422. [PMID: 30395306 DOI: 10.1093/tbm/iby104] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Informal caregivers (ICs) are integral to care provided to patients facing life-threatening or incurable illnesses. This responsibility causes considerable burden, as approximately one half of ICs report clinically significant symptoms of depression and/or anxiety that persist when left untreated. Psychosocial interventions containing efficacious treatment principles (e.g., cognitive behavior therapy [CBT]) show disappointing results in reducing anxiety and depression in ICs. This may reflect failure of these interventions to specifically target crucial mechanisms underlying the central feature of distress caused by the patient's illness-notably, perseverative negative thinking (PNT). Emotion Regulation Therapy (ERT) is an efficacious CBT developed to explicitly target mechanisms underlying PNT and the emotional concomitants that arise in response to stressful situations. This open trial was conducted to evaluate the acceptability and initial efficacy of ERT adapted to the experience of cancer ICs (ERT-C). Thirty-one ICs provided informed consent and completed eight weekly individual sessions of ERT-C. Participants completed self-report measures of depression and anxiety symptoms, PNT, emotion regulation deficits, and caregiver burden before and after treatment. ERT-C was well tolerated as indicated by 22 treatment completers and feedback provided in exit interviews. ICs demonstrated reduced depression and anxiety symptoms, PNT, and emotion regulation deficits with moderate to large effect sizes (Hedge's g range: 0.36-0.92). Notably, caregiver burden was not reduced but ICs expressed more ability to confront caregiving-related challenges. Findings offer promising but preliminary support for ERT-C as a conceptual model and treatment modality for distressed cancer ICs.
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Affiliation(s)
- Allison J Applebaum
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Kara Buda
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Mia S O'Toole
- Department of Psychology & Behavioral Sciences, Aarhus, Denmark
| | | | - Adam Garcia
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
| | - David M Fresco
- Department of Psychological Sciences, Kent State University, Kent, OH
| | - Douglas S Mennin
- Department of Psychology, Teachers College, Columbia, New York, NY
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20
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van Roij J, Brom L, Sommeijer D, van de Poll-Franse L, Raijmakers N. Self-care, resilience, and caregiver burden in relatives of patients with advanced cancer: results from the eQuiPe study. Support Care Cancer 2021; 29:7975-7984. [PMID: 34215933 PMCID: PMC8549961 DOI: 10.1007/s00520-021-06365-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 06/13/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Relatives are often involved in caregiving for patients with advanced cancer and carry a heavy burden. Self-care and resilience might be beneficial to enhance their wellbeing and burden-bearing capacity. This study assessed the engagement in self-care and resilience in relatives of patients with advanced cancer and its association with their caregiver burden. METHODS This study analyzed baseline data of the eQuiPe study, a prospective longitudinal, multicenter, observational study on quality of care and life of patients with advanced cancer and their relatives in which self-care (Self-care Practices Scale), resilience (Connor-Davidson Resilience Scale), and caregiver burden (Zarit Burden Interview (ZBI)) of relatives were included. Their scores were compared with a gender- and age-matched normative population. Multivariable logistic regression analysis was performed to assess the association between self-care and resilience with caregiver burden. RESULTS Most of the 746 relatives were the patient's partner (78%) and 54% reported to be an informal caregiver of the patient. The median hours of caregiving a week for all relatives was 15 and 11% experienced high caregiver burden (ZBI > 20). Relatives who reported a high caregiver burden engaged less often in self-care (OR = .87) and were less resilient (OR = .76) compared to relatives with low/medium caregiver burden. Relatives with high caregiver burden were younger (OR = .96), highly educated (OR = 2.08), often reported to be an informal caregiver of the patient (OR = 2.24), and were less well informed about the importance of self-care (OR = .39). CONCLUSION A significant number of relatives of patients with advanced cancer experienced high caregiver burden. As more self-care and resilience were associated with lower experienced caregiver burden, creating awareness of the beneficial potential of self-care is important. Future studies should illuminate the causal relation. TRIAL REGISTRATION NUMBER NTR6584 (date of registration: 30 June 2017).
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Affiliation(s)
- Janneke van Roij
- Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), PO box 19079, 3501 DB, Utrecht, The Netherlands.,CoRPS-Center of Research On Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands.,Netherlands Association for Palliative Care (PZNL), Utrecht, The Netherlands.,Libra Rehabilitation and Audiology, Tilburg, The Netherlands
| | - Linda Brom
- Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), PO box 19079, 3501 DB, Utrecht, The Netherlands.,Netherlands Association for Palliative Care (PZNL), Utrecht, The Netherlands
| | - Dirkje Sommeijer
- Department of Medical Oncology, Amsterdam University Medical Center, Amsterdam, The Netherlands.,Department of Medical Oncology, Almere, The Netherlands
| | - Lonneke van de Poll-Franse
- Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), PO box 19079, 3501 DB, Utrecht, The Netherlands.,CoRPS-Center of Research On Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands.,Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Natasja Raijmakers
- Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), PO box 19079, 3501 DB, Utrecht, The Netherlands. .,Netherlands Association for Palliative Care (PZNL), Utrecht, The Netherlands.
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21
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Torres GCS, Sumile EFR, Rebueno MCDR, Parial LLB, Malong-Consolacion CP, Estrada MG, Macindo JRB, Hendrix CC. Exploring the challenges and needs of home caregivers of hemodialysis patients in the Philippines: A mixed methods study. Nurs Forum 2021; 56:823-833. [PMID: 34080194 DOI: 10.1111/nuf.12618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 05/17/2021] [Accepted: 05/20/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Although the importance of home caregivers of chronic kidney disease patients has been increasingly recognized, their perceived caregiving difficulties and requisites remain underexplored. This study investigated the challenges and needs of home caregivers of hemodialysis patients in the Philippines. METHODS We utilized a mixed-method (QUAN + qual), explanatory sequential design. Data were collected from July 2017 to May 2018 from 46 home caregivers of hemodialysis patients. A three-part researcher-made survey were developed from literature search, personal values and cultural context, while some items were generated from a standardized tool that measures caregiver infrastructure and needs of those caring from frail US veterans. The tool developed gathered the participants' profile, caregiving characteristics, and related needs. The tool was validated and pretested for reliability. Fifteen participants were also interviewed to explore caregiving challenges and needs. Descriptive and χ2 statistics were used for quantitative outcomes, while thematic analysis was employed for qualitative data. RESULTS Participants provided moderate assistance to patients, spending an average of 10.65 h/day and 5.08 days/week in caregiving. The most difficult caregiving circumstances were having costly expenses (78.26%); missing work (50.00%); and experiencing negative feelings (47.83%), stress (43.48%), and physical difficulties (34.78%). They also had the lowest confidence in deciding when to contact health providers (x̅ = 3.31, SD = 0.94) and finding patient care services (x̅ = 2.93, SD = 1.08). Qualitative findings further revealed caregiving needs and challenges in cost management, physical and psychological health, assumption of multiple roles, lifestyle adjustment, and reinforcement of carer knowledge, skills, and attitudes. CONCLUSION Supportive strategies are needed to address the challenges encountered by home caregivers of hemodialysis patients. Findings can be utilized in developing appropriate interventions for home caregivers in low-resource settings where home caregiving and healthcare system issues, such as lack of access to resources and social support, are prevalent.
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Affiliation(s)
| | - Earl Francis R Sumile
- College of Nursing, University of Santo Tomas, Manila, Philippines.,Graduate School, Centro Escolar University, Mendiola, Manila, Philippines
| | | | - Laurence Lloyd B Parial
- College of Nursing, University of Santo Tomas, Manila, Philippines.,School of Nursing, Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR
| | | | - Marica G Estrada
- College of Nursing, University of Santo Tomas, Manila, Philippines
| | - John Rey B Macindo
- Division of Nursing Service, AMOSUP Seamen's Hospital, Manila, Philippines
| | - Cristina C Hendrix
- Division of Health Systems and Analytics, Duke University School of Nursing, Durham, North Carolina, USA
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22
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Interventional Therapies for Pain in Cancer Patients: a Narrative Review. Curr Pain Headache Rep 2021; 25:44. [PMID: 33961156 DOI: 10.1007/s11916-021-00963-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE OF REVIEW Pain is a prevalent symptom in the lives of patients with cancer. In light of the ongoing opioid epidemic and increasing awareness of the potential for opioid abuse and addiction, clinicians are progressively turning to interventional therapies. This article reviews the interventional techniques available to mitigate the debilitating effects that untreated or poorly treated pain have in this population. RECENT FINDINGS A range of interventional therapies and technical approaches are available for the treatment of cancer-related pain. Many of the techniques described may offer effective analgesia with less systemic toxicity and dependency than first- and second-line oral and parenteral agents. Neuromodulatory techniques including dorsal root ganglion stimulation and peripheral nerve stimulation are increasingly finding roles in the management of oncologic pain. The goal of this pragmatic narrative review is to discuss interventional approaches to cancer-related pain and the potential of such therapies to improve the quality of life of cancer patients.
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23
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Fei F, Koffman J, Zhang X, Gao W. Chronic Obstructive Pulmonary Disease Symptom Cluster Composition, Associated Factors, and Methodologies: A Systematic Review. West J Nurs Res 2021; 44:395-415. [PMID: 33682534 PMCID: PMC8894625 DOI: 10.1177/0193945921995773] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This systematic review details symptom clusters, their compositions, and associated factors and appraises the methodologies of studies that reported symptom clusters in patients with chronic obstructive pulmonary disease (COPD). Ten studies were eligible for inclusion in this study. Four common symptom clusters were identified. Two theoretical frameworks, four statistical methods, and various symptom assessment tools were used to identify symptom clusters. Factors associated with symptom clusters included demographic, clinical, and biological factors. No studies examined the subjective experiences of symptom clusters. Overall, inconsistencies were identified in the composition of symptom clusters across studies. This may be due to variations in study design, assessment tools, and statistical methods. Future studies should attempt to arrive at a common definition, especially that is theoretically derived, for symptom clusters, standardize the criteria for symptoms for inclusion in the clusters, and focus on patients' subjective experience to inform which clusters are clinically relevant.
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Affiliation(s)
- Fei Fei
- Cicely Saunders Institute, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK.,School of Nursing and Midwifery, Jiangsu College of Nursing, Huai'an, Jiangsu, P.R. China
| | - Jonathan Koffman
- Cicely Saunders Institute, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Xiaohan Zhang
- School of Nursing and Midwifery, Jiangsu College of Nursing, Huai'an, Jiangsu, P.R. China
| | - Wei Gao
- Cicely Saunders Institute, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
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24
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Davis MP, Rybicki LA, Samala RV, Patel C, Parala-Metz A, Lagman R. Pain or fatigue: which correlates more with suffering in hospitalized cancer patients? Support Care Cancer 2021; 29:4535-4542. [PMID: 33479793 DOI: 10.1007/s00520-021-05996-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 01/12/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The association of pain and suffering seems intuitive, but evidence substantiating this association is lacking. In studies of cancer patients, fatigue, rather than pain, is the most prevalent and debilitating symptom. This study aimed to compare the correlation of pain and fatigue to suffering, and identify other potential sources of suffering in cancer patients treated in a palliative care unit. METHODS One hundred fifty cancer patients were surveyed. Fifteen variables were measured on a 0- to 10-point scale: suffering, pain, level of acceptable pain, effect of pain on quality of life, fatigue, level of acceptable fatigue, effect of fatigue on quality of life, and specific types of suffering. Univariable associations with suffering were made with Pearson correlation (continuous variables) or t test (binary predictors). Multivariable associations with suffering were assessed with linear regression analysis and bootstrapping. RESULTS In multivariable analysis, highest pain (parameter estimate 0.38) had a greater impact on suffering than highest fatigue (parameter estimate 0.21). When other variables were assessed, 38% of the variability in suffering was accounted for by pain "now", fatigue in the past 24 hours, and age. CONCLUSION The most important predictors of greater suffering in hospitalized cancer patients are pain, younger age, and fatigue. Despite their significant effect on suffering, other underlying contributors to suffering have yet to be identified. Designing interventions to reduce fatigue, in addition to pain management, may help in alleviating overall suffering.
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Affiliation(s)
- Mellar P Davis
- Department of Palliative and Supportive Care, Cleveland Clinic, 9500 Euclid Ave. CA-53, Cleveland, OH, 44195, USA
| | - Lisa A Rybicki
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Renato V Samala
- Department of Palliative and Supportive Care, Cleveland Clinic, 9500 Euclid Ave. CA-53, Cleveland, OH, 44195, USA.
| | - Chirag Patel
- Department of Palliative and Supportive Care, Cleveland Clinic, 9500 Euclid Ave. CA-53, Cleveland, OH, 44195, USA
| | - Armida Parala-Metz
- Department of Palliative and Supportive Care, Cleveland Clinic, 9500 Euclid Ave. CA-53, Cleveland, OH, 44195, USA
| | - Ruth Lagman
- Department of Palliative and Supportive Care, Cleveland Clinic, 9500 Euclid Ave. CA-53, Cleveland, OH, 44195, USA
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25
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Strayhorn SM, Carnahan LR, Zimmermann K, Hastert TA, Watson KS, Ferrans CE, Molina Y. Comorbidities, treatment-related consequences, and health-related quality of life among rural cancer survivors. Support Care Cancer 2020; 28:1839-1848. [PMID: 31342166 PMCID: PMC6980904 DOI: 10.1007/s00520-019-05005-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 07/17/2019] [Indexed: 12/31/2022]
Abstract
PURPOSE We explored how lifetime comorbidities and treatment-related cancer symptoms were associated with quality of life (QOL) in rural cancer survivors. METHODS Survivors (n = 125) who were rural Illinois residents aged 18+ years old were recruited from January 2017 to September 2018. We conducted 4 multivariable regressions with QOL domains as outcomes (social well-being, functional well-being, mental health-MHQOL, physical health-PHQOL); the number of physical and psychological comorbidities (e.g., arthritis, high blood pressure, stroke) and treatment-related cancer symptoms (e.g., worrying, feeling sad, lack of appetite, lack of energy) as predictors; and, cancer-related and demographic factors related to these variables as covariates. RESULTS The number of comorbidities and number of treatment-related symptoms were inversely associated with functional well-being (Std β = - 0.36, p < 0.0001 and - 0.18, p = 0.03), and MHQOL (Std β = - 0.30, p = 0.001 and Std β = - 0.25, p = 0.004). Comorbidities were associated inversely with social well-being (Std β = - 0.27, p = .003). Comorbidities and treatment-related symptoms were not associated with PHQOL (p = 0.20-0.24). Sensitivity analyses suggested that psychological comorbidities, treatment-related psychological symptoms, and physical comorbidities were associated with social well-being, functional well-being, and MHQOL. CONCLUSIONS Our study highlights the utility of risk-based survivorship care plans to address the negative, additive impact of comorbidities and the treatment-related symptoms to improve the health-related QOL among rural survivors. Future research should assess how contextual factors (e.g., geographic distance to oncologists and other providers) should be incorporated in survivorship care planning and implementation for rural survivors.
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Affiliation(s)
- Shaila M Strayhorn
- University of Illinois at Chicago Institute for Health Research and Policy, 1747 W. Roosevelt Rd., Chicago, IL, 60608, USA
| | - Leslie R Carnahan
- University of Illinois at Chicago Center for Research on Women and Gender, 1640 W. Roosevelt Rd., Chicago, IL, 60608, USA
| | - Kristine Zimmermann
- University of Illinois at Chicago Center for Research on Women and Gender, 1640 W. Roosevelt Rd., Chicago, IL, 60608, USA
| | - Theresa A Hastert
- Karmanos Cancer Institute of Wayne State University, 4100 John R St, Detroit, MI, 48201, USA
| | - Karriem S Watson
- University of Illinois Cancer Center, 914 S. Wood St., Chicago, IL, 60612, USA
| | - Carol Estwing Ferrans
- University of Illinois at Chicago College of Nursing, 845 S. Damen Ave., Chicago, IL, 60612, USA
| | - Yamilé Molina
- University of Illinois at Chicago Center for Research on Women and Gender, 1640 W. Roosevelt Rd., Chicago, IL, 60608, USA.
- Karmanos Cancer Institute of Wayne State University, 4100 John R St, Detroit, MI, 48201, USA.
- Division of Community Health Sciences, School of Public Health, 1603 W. Taylor St., MC 923, Chicago, USA.
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26
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Palmer ACS, Souza A, Dos Santos VS, Cavalheiro JAC, Schuh F, Zucatto AE, Biazus JV, Torres ILDS, Fregni F, Caumo W. The Effects of Melatonin on the Descending Pain Inhibitory System and Neural Plasticity Markers in Breast Cancer Patients Receiving Chemotherapy: Randomized, Double-Blinded, Placebo-Controlled Trial. Front Pharmacol 2019; 10:1382. [PMID: 31824318 PMCID: PMC6883914 DOI: 10.3389/fphar.2019.01382] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 10/30/2019] [Indexed: 12/17/2022] Open
Abstract
Background: Adjuvant chemotherapy for breast cancer (ACBC) has been associated with fatigue, pain, depressive symptoms, and disturbed sleep. And, previous studies in non-cancer patients showed that melatonin could improve the descending pain modulatory system (DPMS). We tested the hypothesis that melatonin use before and during the first cycle of ACBC is better than placebo at improving the DPMS function assessed by changes in the 0–10 Numerical Pain Scale (NPS) during the conditioned pain modulating task (CPM-task) (primary outcome). The effects of melatonin were evaluated in the following secondary endpoints: heat pain threshold (HPT), heat pain tolerance (HPTo), and neuroplasticity state assessed by serum brain-derived neurotrophic factor (BDNF), tropomyosin kinase receptor B, and S100B-protein and whether melatonin’s effects on pain and neuroplasticity state are due more so to its impact on sleep quality. Methods: Thirty-six women, ages 18 to 75 years old, scheduled for their first cycle of ACBC were randomized to receive 20mg of oral melatonin (n = 18) or placebo (n = 18). The effect of treatment on the outcomes was analyzed by delta (Δ)-values (from pre to treatment end). Results: Multivariate analyses of covariance revealed that melatonin improved the function of the DPMS. The Δ-mean (SD) on the NPS (0–10) during the CPM-task in the placebo group was −1.91 [−1.81 (1.67) vs. −0.1 (1.61)], and in the melatonin group was −3.5 [−0.94 (1.61) vs. −2.29 (1.61)], and the mean difference (md) between treatment groups was 1.59 [(95% CI, 0.50 to 2.68). Melatonin’s effect increased the HPTo and HPT while reducing the (Δ)-means of the serum neuroplasticity marker in placebo vs. melatonin. The Δ-BDNF is 1.87 (7.17) vs. −20.44 (17.17), respectively, and the md = 22.31 [(95% CI = 13.40 to 31.22)]; TrKB md = 0.61 [0.46 (0.17) vs. −0.15 (0.18); 95% CI = 0.49 to 0.73)] and S00B-protein md = −8.27[(2.89 (11.18) vs. −11.16 (9.75); 95% CI = −15.38 to −1.16)]. However, melatonin’s effect on pain and the neuroplastic state are not due to its effect on sleep quality. Conclusions: These results suggest that oral melatonin, together with the first ACBC counteracts the dysfunction in the inhibitory DPMS and improves pain perception measures. Also, it shows that changes in the neuroplasticity state mediate the impact of melatonin on pain. Clinical Trial Registration:www.ClinicalTrials.gov, identifier NCT03205033.
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Affiliation(s)
- Ana Claudia Souza Palmer
- Post-graduate Program in Pharmacology and Therapeutics, Department of Pharmacology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Andressa Souza
- Postgraduate Program in Health and Human Development, La Salle University Center, Canoas, Brazil
| | - Vinicius Souza Dos Santos
- Post-graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - José Antônio Crespo Cavalheiro
- Division of Breast Surgery, Hospital de Clinicas de Porto Alegre (HCPA), Postgraduate Program in Gynecology and Obstetrics, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Fernando Schuh
- Division of Breast Surgery, Hospital de Clinicas de Porto Alegre (HCPA), Postgraduate Program in Gynecology and Obstetrics, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Angela Erguy Zucatto
- Division of Breast Surgery, Hospital de Clinicas de Porto Alegre (HCPA), Postgraduate Program in Gynecology and Obstetrics, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Jorge Villanova Biazus
- Division of Breast Surgery, Hospital de Clinicas de Porto Alegre (HCPA), Postgraduate Program in Gynecology and Obstetrics, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Iraci Lucena Da S Torres
- Post-graduate Program in Pharmacology and Therapeutics, Department of Pharmacology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,Pharmacology Department, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Felipe Fregni
- Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, United States
| | - Wolnei Caumo
- Post-graduate Program in Pharmacology and Therapeutics, Department of Pharmacology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,Post-graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,Pharmacology Department, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,Anesthesiology, Pain and Palliative Care Service, Hospital de Clínicas de Porto Alegre (HCPA), Department of Surgery, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
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27
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Prevalence of depression and burden among informal care-givers of people with dementia: a meta-analysis. AGEING & SOCIETY 2019. [DOI: 10.1017/s0144686x19000527] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
AbstractThis meta-analysis examined the prevalence of depression and burden among informal care-givers of people with dementia (PwD) and compared the prevalence of depression between male and female, and spousal and non-spousal, care-givers. The quality of studies was evaluated and moderator variables explored. A search of six electronic databases (PsycARTICLES, PsycINFO, MEDLINE Complete, SCOPUS, Web of Science and ProQuest) was conducted from the first available date to the 31 October 2017. Inclusion criteria involved observational studies on the prevalence of burden or depression among informal care-givers of PwD. Forty-three studies were examined with a total of 16,911 participants. The adjusted pooled prevalence of depression was 31.24 per cent (95% confidence interval (CI) = 27.70, 35.01) and burden was 49.26 per cent (95% CI = 37.15, 61.46), although heterogeneity among prevalence estimates was high. Depression prevalence estimates differed according to the instrument used and the continent where the study was conducted. The odds of having depression were almost one and a half times higher in female compared to male care-givers. No significant difference was observed between spouses and non-spouses. Most studies had a medium risk of bias. Results suggest a great need within this population for interventions that are effective at reducing burden and depressive symptoms. It therefore appears imperative for dementia services that are not providing such interventions to do so.
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28
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Steffen LE, Cheavens JS, Vowles KE, Gabbard J, Nguyen H, Gan GN, Edelman MJ, Smith BW. Hope-related goal cognitions and daily experiences of fatigue, pain, and functional concern among lung cancer patients. Support Care Cancer 2019; 28:827-835. [PMID: 31152302 DOI: 10.1007/s00520-019-04878-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 05/16/2019] [Indexed: 01/22/2023]
Abstract
PURPOSE Cross-sectional research suggests that thinking about multiple ways to reach goals (hope pathways) and the belief that one can reach them (hope agency) may be adaptive for lung cancer patients. We examined the between-person and within-person associations among aspects of hope agency and pathways thinking, daily fatigue, pain, and functional concerns (e.g., sense of independence, usefulness) among lung cancer patients during active treatment. METHODS Data from a daily diary study were used to examine relations among hope agency, hope pathways, fatigue, pain, and functional concern in 50 patients with advanced lung cancer. Participants were accrued from one outpatient cancer center and completed the study between 2014 and 2015. RESULTS Adjusting for covariates and the previous day's symptoms or concern, patients who engaged in higher pathways thinking reported lower daily symptoms, whereas those who engaged in higher agency thinking reported less functional concern. Within-person increases in pathways thinking were associated with less daily fatigue, pain, and functional concern; within-person increases in agency thinking were associated with less daily fatigue and pain. Models examining symptoms and concerns as predictors of hope suggested within-person increases in functional concern and fatigue and pain were related to lower agency and pathways thinking the same day. Patients with higher fatigue and pain did not report lower agency or pathways thinking, but patients with more functional concern did. CONCLUSIONS Increases in hope pathways thinking may be associated with lower symptoms and better functioning in lung cancer patients. This suggests that it is important to determine the efficacy of interventions that emphasize the pathways the component of hope.
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Affiliation(s)
- Laurie E Steffen
- Social Sciences & Health Policy - PHS, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA.
| | | | - Kevin E Vowles
- Department of Psychology, University of New Mexico, Albuquerque, NM, USA
| | - Jennifer Gabbard
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Huynh Nguyen
- School of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Gregory N Gan
- Department of Radiation Oncology, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Martin J Edelman
- Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Bruce W Smith
- Department of Psychology, University of New Mexico, Albuquerque, NM, USA
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29
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Orsak G, McGaha P, Brandon P, Swan A, Singh KP. A Longitudinal Pilot Study for Examining Symptom Reduction in Patients With Cancer in a Palliative Care Program: A Primarily Rural Northeast Texas Population. Hosp Top 2019; 97:54-59. [PMID: 31012812 DOI: 10.1080/00185868.2019.1605322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Many patients with cancer live in rural areas and research is lacking on the efficacy of palliative care programs in rural community settings. This pilot study was conducted in a primarily rural setting where healthcare professionals delivered palliative care to 52 mostly lower income patients with a variety of cancers. They were assessed for physical, financial, psychosocial and overall symptom intensity at baseline and at three consequent assessments. This pilot study demonstrated the potential efficacy of an outpatient palliative care program in a mostly rural setting in the reduction of physical, psychosocial, and overall symptom intensity in patients with cancer.
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Affiliation(s)
- Gabriela Orsak
- a Department of Epidemiology and Biostatistics, School of Rural and Community Health , University of Texas Health Science Center at Tyler , Tyler , TX , USA
| | - Paul McGaha
- b Department of Community Health, School of Rural and Community Health , University of Texas Health Science Center at Tyler , Tyler , TX , USA
| | - Paula Brandon
- c Department of Clinical and Quality Support , Community Hospital Corporation , Dallas , TX , USA
| | - Amy Swan
- d Department of Family Medicine , University of Texas Health Science Center at Tyler , Tyler , TX , USA
| | - Karan P Singh
- a Department of Epidemiology and Biostatistics, School of Rural and Community Health , University of Texas Health Science Center at Tyler , Tyler , TX , USA
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30
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Yang P. Maximizing quality of life remains an ultimate goal in the era of precision medicine: exemplified by lung cancer. PRECISION CLINICAL MEDICINE 2019; 2:8-12. [PMID: 35694702 PMCID: PMC8985777 DOI: 10.1093/pcmedi/pbz001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 01/22/2019] [Indexed: 11/23/2022] Open
Abstract
An ultimate goal of precision medicine in lung cancer treatment is to restore patient health with maximized quality of life (QOL). Results from Mayo Clinic studies show that a significant improvement in fatigue, dyspnea, and pain scales could lead to better overall QOL. Although treatments and guidelines for clinical implementation to alleviate these key symptoms are available, few cancer patients receive adequate therapy, mostly because of limitations in current care delivery systems and unclear clinicians’ roles. For optimal care of lung cancer survivors in different subpopulations, three barriers must be overcome: physicians’ lack of knowledge, unwarranted practice variation, and uncertainty regarding care provider roles. Appropriate culturally adapted, tested and validated tools for QOL measures must be developed, rather than directly translating existing tools between different languages and across cultures or diverse subpopulations. Finally, lack of sensitive, adequate, and relevant tools in measuring health-related QOL (HRQOL) has long been an issue for effective data collection, demanding a global consensus on a set of core components that reflect the needs of all critical parties for the best cure and care, supporting patients to achieve optimal HRQOL.
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Affiliation(s)
- Ping Yang
- Mayo Clinic College of Medicine and Science, Mayo Clinic Arizona, 13400 E. Shea Boulevard, Scottsdale, AZ, USA
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31
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Cummings A, Grimmett C, Calman L, Patel M, Permyakova NV, Winter J, Corner J, Din A, Fenlon D, Richardson A, Smith PW, Foster C. Comorbidities are associated with poorer quality of life and functioning and worse symptoms in the 5 years following colorectal cancer surgery: Results from the ColoREctal Well-being (CREW) cohort study. Psychooncology 2018; 27:2427-2435. [PMID: 30070052 PMCID: PMC6221152 DOI: 10.1002/pon.4845] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 07/18/2018] [Accepted: 07/19/2018] [Indexed: 12/13/2022]
Abstract
Objective More people are living with the consequences of cancer and comorbidity. We describe frequencies of comorbidities in a colorectal cancer cohort and associations with health and well‐being outcomes up to 5 years following surgery. Methods Prospective cohort study of 872 colorectal cancer patients recruited 2010 to 2012 from 29 UK centres, awaiting curative intent surgery. Questionnaires administered at baseline (pre‐surgery), 3, 9, 15, 24 months, and annually up to 5 years. Comorbidities (and whether they limit activities) were self‐reported by participants from 3 months. The EORTC QLQ‐C30 and QLQ‐CR29 assessed global health/quality of life (QoL), symptoms, and functioning. Longitudinal analyses investigated associations between comorbidities and health and well‐being outcomes. Results At baseline, the mean age of participants was 68 years, with 60% male and 65% colon cancer. Thirty‐two per cent had 1 and 40% had ≥2 comorbidities. The most common comorbidities were high blood pressure (43%), arthritis/rheumatism (32%), and anxiety/depression (18%). Of those with comorbidities, 37% reported at least 1 that limited their daily activities. Reporting any limiting comorbidities was associated with poorer global health/QoL, worse symptoms, and poorer functioning on all domains over 5‐year follow‐up. Controlling for the most common individual comorbidities, depression/anxiety had the greatest deleterious effect on outcomes. Conclusions Clinical assessment should prioritise patient‐reported comorbidities and whether these comorbidities limit daily activities, as important determinants of recovery of QoL, symptoms, and functioning following colorectal cancer. Targeted interventions and support services, including multiprofessional management and tailored assessment and follow‐up, may aid recovery of health and well‐being in these individuals.
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Affiliation(s)
- Amanda Cummings
- Macmillan Survivorship Research Group, Health Sciences, University of Southampton, Southampton, UK
| | - Chloe Grimmett
- Macmillan Survivorship Research Group, Health Sciences, University of Southampton, Southampton, UK
| | - Lynn Calman
- Macmillan Survivorship Research Group, Health Sciences, University of Southampton, Southampton, UK
| | - Mubarak Patel
- Macmillan Survivorship Research Group, Health Sciences, University of Southampton, Southampton, UK
| | - Natalia Vadimovna Permyakova
- Macmillan Survivorship Research Group, Health Sciences, University of Southampton, Southampton, UK.,Social Statistics and Demography, Social Sciences, University of Southampton, Southampton, UK
| | - Jane Winter
- Macmillan Survivorship Research Group, Health Sciences, University of Southampton, Southampton, UK.,University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Jessica Corner
- Executive Office, University of Nottingham, Nottingham, UK
| | - Amy Din
- Macmillan Survivorship Research Group, Health Sciences, University of Southampton, Southampton, UK
| | - Deborah Fenlon
- College of Health and Human Sciences, Swansea University, Swansea, UK
| | - Alison Richardson
- University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Health Sciences, University of Southampton, Southampton, UK
| | - Peter W Smith
- Social Statistics and Demography, Social Sciences, University of Southampton, Southampton, UK
| | | | - Claire Foster
- Macmillan Survivorship Research Group, Health Sciences, University of Southampton, Southampton, UK
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Flannery M, Stein KF, Dougherty DW, Mohile S, Guido J, Wells N. Nurse-Delivered Symptom Assessment for Individuals With Advanced Lung Cancer. Oncol Nurs Forum 2018; 45:619-630. [PMID: 30118448 PMCID: PMC6379074 DOI: 10.1188/18.onf.619-630] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To assess an intervention derived from self-regulation theory (SRT) to promote well-being for individuals with advanced lung cancer. SAMPLE & SETTING 45 adults with advanced lung cancer who were receiving chemotherapy at an ambulatory cancer center. METHODS & VARIABLES Participants were randomized to the intervention group or usual care control group. Feasibility assessment focused on recruitment, retention, design, methods, and fidelity. Outcome measures of quality of life, symptoms, and distress were collected at four time points. The main research variables were symptoms, quality of life, and distress. RESULTS The participation rate was 79%, and the retention rate was 62%. Participant loss was most often because of progressive disease and occurred early in the study. High fidelity was noted for delivery of the intervention as planned and outcome data collection by telephone. The mean number of interventions delivered was 5.5 of a planned 8. A high level of acceptability was reported for participants completing the intervention. IMPLICATIONS FOR NURSING Although delivering the SRT-derived intervention with fidelity was possible, feasibility findings do not warrant intervention replication in this population.
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Bubis LD, Davis L, Mahar A, Barbera L, Li Q, Moody L, Karanicolas P, Sutradhar R, Coburn NG. Symptom Burden in the First Year After Cancer Diagnosis: An Analysis of Patient-Reported Outcomes. J Clin Oncol 2018; 36:1103-1111. [DOI: 10.1200/jco.2017.76.0876] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Purpose Improvement in the quality of life of patients with cancer requires attention to symptom burden across the continuum of care, with the use of patient-reported outcomes key to achieving optimal care. Yet there have been few studies that have examined symptoms in the early postdiagnosis period during which suboptimal symptom control may be common. A comprehensive analysis of temporal trends and risk factors for symptom burden in newly diagnosed patients with cancer is essential to guide supportive care strategies. Methods A retrospective observational study was performed of patients who were diagnosed with cancer between January 2007 and December 2014 and who survived at least 1 year. Patient-reported Edmonton Symptom Assessment System scores, which are prospectively collected at outpatient visits, were linked to provincial administrative health care data. We described the proportion of patients who reported moderate-to-severe symptom scores by month during the first year after diagnosis according to disease site. Multivariable logistic regression models were constructed to identify risk factors for moderate-to-severe symptom scores. Results Of 120,745 patients, 729,861 symptom assessments were recorded within 12 months of diagnosis. For most symptoms, odds of elevated scores were highest in the first month, whereas nausea had increased odds of elevated scores up to 6 months after diagnosis. On multivariable analysis, cancer site, younger age, higher comorbidity, female sex, lower income, and urban residence were associated with significantly higher odds of elevated symptom burden. Conclusion A high prevalence of moderate-to-severe symptom scores was observed in cancers of all sites. Patients are at risk of experiencing multiple symptoms in the immediate postdiagnosis period, which underscores the need to address supportive care requirements early in the cancer journey. Patient subgroups who are at higher risk of experiencing moderate-to-severe symptoms should be targeted for tailored supportive care interventions.
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Affiliation(s)
- Lev D. Bubis
- Lev D. Bubis, Lisa Barbera, Lesley Moody, Paul Karanicolas, Rinku Sutradhar, and Natalie G. Coburn, University of Toronto; Laura Davis, Alyson Mahar, Paul Karanicolas, and Natalie G. Coburn, Sunnybrook Health Sciences Centre; Lisa Barbera, Qing Li, and Rinku Sutradhar and Natalie G. Coburn, Institute for Clinical Evaluative Sciences; Lisa Barbera and Lesley Moody, Cancer Care Ontario, Toronto, Ontario, Canada
| | - Laura Davis
- Lev D. Bubis, Lisa Barbera, Lesley Moody, Paul Karanicolas, Rinku Sutradhar, and Natalie G. Coburn, University of Toronto; Laura Davis, Alyson Mahar, Paul Karanicolas, and Natalie G. Coburn, Sunnybrook Health Sciences Centre; Lisa Barbera, Qing Li, and Rinku Sutradhar and Natalie G. Coburn, Institute for Clinical Evaluative Sciences; Lisa Barbera and Lesley Moody, Cancer Care Ontario, Toronto, Ontario, Canada
| | - Alyson Mahar
- Lev D. Bubis, Lisa Barbera, Lesley Moody, Paul Karanicolas, Rinku Sutradhar, and Natalie G. Coburn, University of Toronto; Laura Davis, Alyson Mahar, Paul Karanicolas, and Natalie G. Coburn, Sunnybrook Health Sciences Centre; Lisa Barbera, Qing Li, and Rinku Sutradhar and Natalie G. Coburn, Institute for Clinical Evaluative Sciences; Lisa Barbera and Lesley Moody, Cancer Care Ontario, Toronto, Ontario, Canada
| | - Lisa Barbera
- Lev D. Bubis, Lisa Barbera, Lesley Moody, Paul Karanicolas, Rinku Sutradhar, and Natalie G. Coburn, University of Toronto; Laura Davis, Alyson Mahar, Paul Karanicolas, and Natalie G. Coburn, Sunnybrook Health Sciences Centre; Lisa Barbera, Qing Li, and Rinku Sutradhar and Natalie G. Coburn, Institute for Clinical Evaluative Sciences; Lisa Barbera and Lesley Moody, Cancer Care Ontario, Toronto, Ontario, Canada
| | - Qing Li
- Lev D. Bubis, Lisa Barbera, Lesley Moody, Paul Karanicolas, Rinku Sutradhar, and Natalie G. Coburn, University of Toronto; Laura Davis, Alyson Mahar, Paul Karanicolas, and Natalie G. Coburn, Sunnybrook Health Sciences Centre; Lisa Barbera, Qing Li, and Rinku Sutradhar and Natalie G. Coburn, Institute for Clinical Evaluative Sciences; Lisa Barbera and Lesley Moody, Cancer Care Ontario, Toronto, Ontario, Canada
| | - Lesley Moody
- Lev D. Bubis, Lisa Barbera, Lesley Moody, Paul Karanicolas, Rinku Sutradhar, and Natalie G. Coburn, University of Toronto; Laura Davis, Alyson Mahar, Paul Karanicolas, and Natalie G. Coburn, Sunnybrook Health Sciences Centre; Lisa Barbera, Qing Li, and Rinku Sutradhar and Natalie G. Coburn, Institute for Clinical Evaluative Sciences; Lisa Barbera and Lesley Moody, Cancer Care Ontario, Toronto, Ontario, Canada
| | - Paul Karanicolas
- Lev D. Bubis, Lisa Barbera, Lesley Moody, Paul Karanicolas, Rinku Sutradhar, and Natalie G. Coburn, University of Toronto; Laura Davis, Alyson Mahar, Paul Karanicolas, and Natalie G. Coburn, Sunnybrook Health Sciences Centre; Lisa Barbera, Qing Li, and Rinku Sutradhar and Natalie G. Coburn, Institute for Clinical Evaluative Sciences; Lisa Barbera and Lesley Moody, Cancer Care Ontario, Toronto, Ontario, Canada
| | - Rinku Sutradhar
- Lev D. Bubis, Lisa Barbera, Lesley Moody, Paul Karanicolas, Rinku Sutradhar, and Natalie G. Coburn, University of Toronto; Laura Davis, Alyson Mahar, Paul Karanicolas, and Natalie G. Coburn, Sunnybrook Health Sciences Centre; Lisa Barbera, Qing Li, and Rinku Sutradhar and Natalie G. Coburn, Institute for Clinical Evaluative Sciences; Lisa Barbera and Lesley Moody, Cancer Care Ontario, Toronto, Ontario, Canada
| | - Natalie G. Coburn
- Lev D. Bubis, Lisa Barbera, Lesley Moody, Paul Karanicolas, Rinku Sutradhar, and Natalie G. Coburn, University of Toronto; Laura Davis, Alyson Mahar, Paul Karanicolas, and Natalie G. Coburn, Sunnybrook Health Sciences Centre; Lisa Barbera, Qing Li, and Rinku Sutradhar and Natalie G. Coburn, Institute for Clinical Evaluative Sciences; Lisa Barbera and Lesley Moody, Cancer Care Ontario, Toronto, Ontario, Canada
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Zou G, Li Y, Xu R, Li P. Resilience and positive affect contribute to lower cancer-related fatigue among Chinese patients with gastric cancer. J Clin Nurs 2018; 27:e1412-e1418. [PMID: 29266530 DOI: 10.1111/jocn.14245] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2017] [Indexed: 12/16/2022]
Abstract
AIMS AND OBJECTIVES To investigate the prevalence of cancer-related fatigue and explore the relationship between resilience, positive affect, and fatigue among Chinese patients with gastric cancer. BACKGROUND Cancer-related fatigue is the most distressing symptom reported frequently by cancer patients during both treatment and survival phases. Resilience and positive affect as vital protective factors against cancer-related fatigue have been examined, but the underlying psychological mechanisms are not well understood. DESIGN A cross-sectional study. METHODS Two hundred and three gastric cancer patients were enrolled from three hospitals in China. The Cancer Fatigue Scale, the positive affect subscale of the Positive and Negative Affect Schedule and the Connor-Davidson Resilience Scale (CD-RISC10) were administered. Hierarchical linear regression modelling was conducted to examine the association between resilience and cancer-related fatigue, and the mediating effect of positive affect. RESULTS The incidence of clinically relevant fatigue among patients with gastric cancer was 91.6%. Regression analysis showed that resilience was negatively associated with cancer-related fatigue, explaining 15.4% of variance in cancer-related fatigue. Mediation analysis showed that high resilience was associated with increased positive affect, which was associated with decreased cancer-related fatigue. CONCLUSIONS Cancer-related fatigue is prevalent among patients with gastric cancer. Positive affect may mediate the relationship between resilience and cancer-related fatigue. RELEVANCE TO CLINICAL PRACTICE Interventions that attend to resilience training and promotion of positive affect may be the focus for future clinical and research endeavours.
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Affiliation(s)
- Guiyuan Zou
- School of Nursing, Shandong University, Jinan, Shandong Province, China.,Shandong Mental Health Center, Jinan, Shandong Province, China
| | - Ye Li
- Linyi People's Hospital, Linyi, Shandong Province, China
| | - Ruicai Xu
- Shandong Provincial Hospital, Jinan, Shandong Province, China
| | - Ping Li
- School of Nursing, Shandong University, Jinan, Shandong Province, China
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Ping Q, Yang CC, Marshall SA, Avis NE, Ip EH. Breast Cancer Symptom Clusters Derived from Social Media and Research Study Data Using Improved K-Medoid Clustering. IEEE TRANSACTIONS ON COMPUTATIONAL SOCIAL SYSTEMS 2016; 3:63-74. [PMID: 29152536 PMCID: PMC5687581 DOI: 10.1109/tcss.2016.2615850] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Most cancer patients, including patients with breast cancer, experience multiple symptoms simultaneously while receiving active treatment. Some symptoms tend to occur together and may be related, such as hot flashes and night sweats. Co-occurring symptoms may have a multiplicative effect on patients' functioning, mental health, and quality of life. Symptom clusters in the context of oncology were originally described as groups of three or more related symptoms. Some authors have suggested symptom clusters may have practical applications, such as the formulation of more effective therapeutic interventions that address the combined effects of symptoms rather than treating each symptom separately. Most studies that have sought to identify clusters in breast cancer survivors have relied on traditional research studies. Social media, such as online health-related forums, contain a bevy of user-generated content in the form of threads and posts, and could be used as a data source to identify and characterize symptom clusters among cancer patients. The present study seeks to determine patterns of symptom clusters in breast cancer survivors derived from both social media and research study data using improved K-Medoid clustering. A total of 50,426 publicly available messages were collected from Medhelp.com and 653 questionnaires were collected as part of a research study. The network of symptoms built from social media was sparse compared to that of the research study data, making the social media data easier to partition. The proposed revised K-Medoid clustering helps to improve the clustering performance by re-assigning some of the negative-ASW (average silhouette width) symptoms to other clusters after initial K-Medoid clustering. This retains an overall non-decreasing ASW and avoids the problem of trapping in local optima. The overall ASW, individual ASW, and improved interpretation of the final clustering solution suggest improvement. The clustering results suggest that some symptom clusters are consistent across social media data and clinical data, such as gastrointestinal (GI) related symptoms, menopausal symptoms, mood-change symptoms, cognitive impairment and pain-related symptoms. We recommend an integrative approach taking advantage of both data sources. Social media data could provide context for the interpretation of clustering results derived from research study data, while research study data could compensate for the risk of lower precision and recall found using social media data.
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Affiliation(s)
- Qing Ping
- PhD student in the College of Computing & Informatics, Drexel University, Philadelphia, PA 19104 USA
| | | | - Sarah A. Marshall
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - Nancy E. Avis
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC 27157 USA
| | - Edward H. Ip
- Department of Biostatistical Sciences and the Department of Social Sciences & Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC 27157 USA
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Psychosocial and Clinical Correlates of Fatigue in Haemodialysis Patients: the Importance of Patients’ Illness Cognitions and Behaviours. Int J Behav Med 2015; 23:271-281. [DOI: 10.1007/s12529-015-9525-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Hershey DS, Given B, Given C, Corser W, von Eye A. Predictors of diabetes self-management in older adults receiving chemotherapy. Cancer Nurs 2015; 37:97-105. [PMID: 23519039 DOI: 10.1097/ncc.0b013e3182888b14] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cancer patients with diabetes have higher mortality rates and are more likely to develop infections, and be hospitalized during treatment. Hyperglycemia has been hypothesized as one of the factors associated with this increased risk. Diabetes self-management is one of the essential elements used by patients to maintain glucose levels. OBJECTIVE This exploratory study seeks to develop an understanding of the impact cancer treatment can have on overall diabetes self-management and how individual, clinical, and behavioral characteristics may influence or predict the level of diabetes self-management in adults who are undergoing chemotherapy for a solid tumor cancer. METHODS This study was conducted at 8 community-based cancer centers in Michigan and Ohio and used a written, self-administered survey at baseline and a phone survey 8 weeks later. RESULTS Diabetes self-management significantly decreased (P < .001), and the level of symptom severity significantly increased (P < .001) after patients were on chemotherapy for a minimum of 8 weeks. The level of symptom severity and diabetes self-efficacy were significantly predictive of the performance of diabetes self-management activities. CONCLUSIONS Chemotherapy and associated symptoms can have a negative impact on the performance of diabetes self-management activities in adults with both diabetes and cancer, increasing the risk for hyperglycemia and development of complications. IMPLICATIONS FOR PRACTICE Oncology nurses need to be aware of the impact cancer treatment can have on the performance of diabetes self-management activities in adults. Future research needs to test interventions that may assist patients with diabetes and cancer in managing both diseases.
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Affiliation(s)
- Denise Soltow Hershey
- Author Affiliations: College of Nursing (Drs Hershey and B. Given); Department of Family Medicine (Dr C. Given) and Institute for Health Care Studies (Dr. Corser), College of Human Medicine; and Department of Psychology (Dr von Eye), Michigan State University, East Lansing
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Spoelstra SL, Given CW, Sikorskii A, Majumder A, Schueller M, Given BA. Treatment with oral anticancer agents: symptom severity and attribution, and interference with comorbidity management. Oncol Nurs Forum 2015; 42:80-8. [PMID: 25490974 DOI: 10.1188/15.onf.42-01p] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To evaluate the prevalence, severity, and attribution of symptoms, as well as the interference with management of comorbidities, in patients who have been prescribed oral anticancer agents (OAs). DESIGN Descriptive exploratory study. SETTING A comprehensive cancer center and two community-based oncology programs in the midwestern United States. SAMPLE 30 adults undergoing OA treatment. METHODS Five phone interviews were conducted during eight weeks. Linear mixed effects and generalized estimating equations were used to examine symptoms and interference over time. MAIN RESEARCH VARIABLES Symptoms and comorbid conditions. FINDINGS The mean age of participants was 65.1 years. Fifteen participants were female, 25 were Caucasian, and 23 had comorbidities. Twenty-one patients had late-stage cancer, and rates of adherence were 90%. Fatigue, sleep disturbance, and numbness or tingling in hands and feet were highly prevalent symptoms. Younger age was associated with higher symptom severity (p < 0.01) and interference (p = 0.01). Patients with more comorbidities tended to report higher symptom severity. Simultaneous IV chemotherapy was not a predictor of symptom severity or interference over age and comorbidity. Symptoms were most frequently attributed to cancer and its treatment. Patients with a greater number of comorbidities were more likely to include comorbidities in symptom attribution and reported interference from the OA with managing comorbid conditions. CONCLUSIONS Symptoms may be more severe in patients prescribed OAs who are younger and have comorbid conditions. More comorbidities and absence of simultaneous IV chemotherapy increased the likelihood of inclusion of chronic conditions in symptom attribution. Patients reported that OA treatment interfered with comorbidity management. IMPLICATIONS FOR NURSING Nurses need to take comorbidities into account when caring for patients prescribed OAs because the chronic conditions may influence symptom severity and the ability to manage symptoms.
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Affiliation(s)
| | - Charles W Given
- Department of Family Medicine, Michigan State University in East Lansing
| | - Alla Sikorskii
- Department of Statistics and Probability, Michigan State University in East Lansing
| | - Atreyee Majumder
- Department of Statistics and Probability, Michigan State University in East Lansing
| | | | - Barbara A Given
- College of Nursing, Michigan State University in East Lansing
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Abstract
The aim of this study was to evaluate the pain and fatigue levels of elderly cancer patients and to examine whether pain is an independent variable in fatigue development. A total of 250 elderly cancer patients undergoing treatment in the outpatient chemotherapy units and internal medicine clinic at 2 hospitals were enrolled. A "Patient Information Form," the "McGill Melzack Pain Questionnaire," and the "Brief Fatigue Inventory" were used as data instruments. It was determined that all patients had pain and that the mean present pain intensity score was 2.70 ± 0.99, the mean worst pain intensity score was 4.40 ± 0.86, and the mean least pain intensity score was 1.40 ± 0.66. Whereas the existing fatigue severity score of the patients with fatigue (43.6%) was 6.27 ± 2.06, the mean usual fatigue severity of the patients in the last 24 hours was 6.19 ± 1.63 and that the mean worst fatigue severity score in the last 24 hours was 7.29 ± 1.57. When the regression analysis carried out between the pain and fatigue intensities is examined, it was determined that pain is an independent variable in increasing fatigue and that there is a statistically significant relationship (P < .05). It is important that nurses develop strategies to prevent and determine activities to decrease the pain and fatigue of the patients while planning and implementing their holistic care in a relevant manner.
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Wright F, Hammer MJ, D'Eramo Melkus G. Associations between multiple chronic conditions and cancer-related fatigue: an integrative review. Oncol Nurs Forum 2015; 41:399-410. [PMID: 24849813 DOI: 10.1188/14.onf.41-04ap] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PROBLEM IDENTIFICATION To summarize the current state of nursing knowledge related to the association of multiple chronic conditions (MCCs) and cancer-related fatigue (CRF) in patients with solid tumors during chemotherapy. LITERATURE SEARCH A systematic literature search of PubMed, CINAHL®, EMBASE, Cochrane, and ProQuest Dissertations and Theses for primary nursing research from January 2000 to June 2012 that examined the prevalence and/or severity of CRF with MCCs or a single comorbidity.Data Evaluation: The studies were appraised for the clarity and focus of the research question and the appropriateness of the method and research design. A 13-item quality criteria checklist evaluated the data from each article on a 0-2 scale (0 = poor, 1 = fair, 2 = good). DATA ANALYSIS Of 329 abstracts, 21 studies were included in the analysis. The association of MCC and CRF was mostly reported in aggregate, with a mean of three MCCs per patient.Presentation of Findings: Having one or more other comorbidities was significantly associated with the prevalence and severity of CRF. Specifically, arthritis, hypertension, and cardiac disease, although not consistently or clinically defined across studies, are associated with an increased prevalence and severity of CRF. The association of MCC and CRF prevalence and severity was inconsistent because of the variability in the measures used and the time span identified to measure changes. IMPLICATIONS FOR NURSING PRACTICE Awareness of the prevalence of MCCs is essential to support patients experiencing CRF. Holistic nursing assessment of the patient's symptoms-with an awareness of MCCs-would help improve symptom management to limit the effect of CRF.
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Affiliation(s)
- Fay Wright
- College of Nursing, New York University in New York City
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Aprile I, Chiesa S, Padua L, Di Blasi C, Arezzo MF, Valentini V, Di Stasio E, Balducci M. Occurrence and predictors of the fatigue in high-grade glioma patients. Neurol Sci 2015; 36:1363-9. [PMID: 25698127 DOI: 10.1007/s10072-015-2111-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 02/11/2015] [Indexed: 11/12/2022]
Abstract
A better knowledge of the fatigue could be of the greatest importance for the high-grade glioma (HGG) patients, who are a unique and vulnerable population. The aim of this study was to evaluate the occurrence and the predictors of the fatigue in HGG patients, using a specific fatigue scale. The study was designed as a cross-sectional study. The study population included sixty-seven consecutive outpatients with HGG. We used these measures: Brief Fatigue Inventory, Karnofsky Performance Scale, Functional Independence Measure, Brief Psychiatric Rating Scale and Psychological Distress Inventory and SF-36, EORTC QLQ-30 and EORTC QLQ-BN20 for quality of life (QoL). Sixteen out of sixty-seven (23.9 %) patients were affected by Anaplastic Astrocytoma and 51/67 (76.1 %) by Glioblastoma Multiforme. About one-third (36.2 %) of patients had a clinically relevant fatigue (Brief Fatigue Inventory ≥3). In regression analysis, physical and mental aspects of QoL were statistically significant related with fatigue (p < 0.01 and p < 0.02, respectively). Our data underlined the relevant occurrence of fatigue in HGG patients and support the development of further studies exploring a tailored rehabilitation program.
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Affiliation(s)
- Irene Aprile
- Don Carlo Gnocchi Onlus Foundation, Via Maresciallo Caviglia 30, 00194, Rome, Italy,
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Lyons KS, Lee CS, Bennett JA, Nail LM, Fromme E, Hiatt SO, Sayer AG. Symptom incongruence trajectories in lung cancer dyads. J Pain Symptom Manage 2014; 48:1031-40. [PMID: 24747222 DOI: 10.1016/j.jpainsymman.2014.02.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 02/12/2014] [Accepted: 03/20/2014] [Indexed: 10/25/2022]
Abstract
CONTEXT There is little known about the pattern of change in patient-family member symptom incongruence across the lung cancer trajectory. OBJECTIVES This study examined trajectories of patient-family member incongruence in perceptions of patient physical function, pain severity, fatigue, and dyspnea in lung cancer dyads and explored the association with family member grief after patient death. METHODS Lung cancer patients and their family members providing care (n = 109 dyads) rated patient symptoms and physical function five times over 12 months. Symptom incongruence trajectories were analyzed using multilevel modeling. RESULTS Patient-family member incongruence did not significantly change over time, on average, except in the case of patient physical function where incongruence significantly declined. There was significant variability around trajectories of incongruence for all symptoms except fatigue. Exploratory analysis on a subsample of 22 bereaved family members found that incongruence regarding patient fatigue was associated with family member grief two months after patient death. CONCLUSION Findings suggest the importance of modeling symptom incongruence over time and taking a dyadic approach to the illness context to identify interventions that promote adjustment and quality of life for both patient and family member.
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Affiliation(s)
- Karen S Lyons
- School of Nursing, Oregon Health & Science University, Portland, Oregon, USA.
| | - Christopher S Lee
- School of Nursing, Oregon Health & Science University, Portland, Oregon, USA
| | - Jill A Bennett
- School of Nursing, Oregon Health & Science University, Portland, Oregon, USA
| | - Lillian M Nail
- School of Nursing, Oregon Health & Science University, Portland, Oregon, USA
| | - Erik Fromme
- Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Shirin O Hiatt
- School of Nursing, Oregon Health & Science University, Portland, Oregon, USA
| | - Aline G Sayer
- Psychology Department, University of Massachusetts at Amherst, Amherst, Massachusetts, USA
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Reinke LF, Feemster LC, Backhus LM, Gylys-Colwell I, Au DH. Assessment and Management of Symptoms for Outpatients Newly Diagnosed With Lung Cancer. Am J Hosp Palliat Care 2014; 33:178-83. [PMID: 25376224 DOI: 10.1177/1049909114557635] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
RATIONALE Little is known about symptom assessment around the time of lung cancer diagnosis. The purpose of this pilot study was to assess symptoms within 2 months of diagnosis and the frequency with which clinicians addressed symptoms among a cohort of veterans (n = 20) newly diagnosed with lung cancer. We administered questionnaires and then reviewed medical records to identify symptom assessment and management provided by subspecialty clinics for 6 months following diagnosis. RESULTS Half (50%) of the patients were diagnosed with early-stage non-small-cell lung cancer (NSCLC), stage I or II. At baseline, 45% patients rated their overall symptoms as severe. There were no significant differences in symptoms among patients with early- or late-stage NSCLC or small-cell lung cancer. Of the 212 clinic visits over 6 months, 70.2% occurred in oncology. Clinicians most frequently addressed pain although assessment differed by clinic. CONCLUSIONS Veterans with newly diagnosed lung cancer report significant symptom burden. Despite ample opportunities to address patients' symptoms, variations in assessment exist among subspecialty services. Coordinated approaches to symptom assessment are likely needed among patients newly diagnosed with lung cancer.
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Affiliation(s)
- Lynn F Reinke
- Department of Veterans Affairs, Puget Sound Health Care System, Health Services R&D, Seattle, WA, USA Department of Biobehavioral Nursing and Health Systems, University of Washington, School of Nursing, Seattle, WA, USA
| | - Laura C Feemster
- Department of Veterans Affairs, Puget Sound Health Care System, Health Services R&D, Seattle, WA, USA Pulmonary and Critical Care Medicine Division, University of Washington, School of Medicine, Seattle, WA, USA
| | - Leah M Backhus
- Department of Veterans Affairs, Puget Sound Health Care System, Health Services R&D, Seattle, WA, USA University of Washington, School of Surgery, Cardiothoracic Surgery Division, Seattle, WA, USA
| | - Ina Gylys-Colwell
- Department of Veterans Affairs, Puget Sound Health Care System, Health Services R&D, Seattle, WA, USA
| | - David H Au
- Department of Veterans Affairs, Puget Sound Health Care System, Health Services R&D, Seattle, WA, USA Pulmonary and Critical Care Medicine Division, University of Washington, School of Medicine, Seattle, WA, USA
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Wang XS, Woodruff JF. Cancer-related and treatment-related fatigue. Gynecol Oncol 2014; 136:446-52. [PMID: 25458588 DOI: 10.1016/j.ygyno.2014.10.013] [Citation(s) in RCA: 105] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 10/07/2014] [Accepted: 10/11/2014] [Indexed: 12/18/2022]
Abstract
Fatigue is a distressing and persistent symptom for patients with gynecological cancer and for survivors. Debilitating cancer-related fatigue (CRF) is produced by both the disease and its treatment. Although awareness and study of CRF have grown in recent years, consistent assessment has not been a priority in routine medical practice. The pathophysiological mechanisms that induce CRF remain unclear, and effective pharmacological interventions have yet to be established. Based on the literature and our own research results, this review focuses on recent progress toward understanding the nature and causes of CRF and on several promising treatment modalities. Given the prevalence and severity of CRF in the gynecological cancer patient population, establishing standardized fatigue measurement and management methods in routine clinical oncology care is of utmost importance. Whether CRF has an underlying inflammatory cause is still hypothetical, however, and no mechanism-driven symptom intervention is currently in clinical use, even though the development of such interventions would provide patients with greater symptom control. Advancing translational and clinical fatigue research will require anatomical pathway studies and well-designed clinical investigations that focus on the development of mechanism-driven interventions based on physiological-behavioral fatigue research, implementation of guidelines for experimental designs, and discovery of biomarkers identifying individuals at high risk for CRF. Validated patient-reported outcomes measures are an essential component of such clinical studies. Because numerous subscales, unidimensional measures, and multidimensional measures exist, clinicians and researchers should consider individual circumstances, good clinical practice, and research goals as guides for choosing the most appropriate fatigue measurement tool. Additionally, education about CRF should be made available to all patients and their caregivers, as accurate and age-appropriate information about conditions like CRF can alleviate much of the stress and anxiety brought on by poor communication about this distressing condition.
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Affiliation(s)
- Xin Shelley Wang
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Jeanie F Woodruff
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Kim HJ, Malone PS, Barsevick AM. Subgroups of cancer patients with unique pain and fatigue experiences during chemotherapy. J Pain Symptom Manage 2014; 48:558-68. [PMID: 24766741 PMCID: PMC4407805 DOI: 10.1016/j.jpainsymman.2013.10.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 09/26/2013] [Accepted: 10/30/2013] [Indexed: 11/23/2022]
Abstract
CONTEXT Some cancer patients experience pain and fatigue, whereas others experience only one of the two symptoms. Yet, it is not clear who experiences these unique patterns and why. OBJECTIVES This study aimed to identify subgroups of cancer patients with unique pain and fatigue experiences in two different chemotherapy cycles to examine how selected factors influenced subgroup membership and identify how subgroups differed in concurrently measured functional limitation outcome. METHODS The sample included 276 patients with diverse cancer types from four U.S. sites. To investigate subgroups, latent profile analyses were performed. Multinomial logistic regression and one-way analysis of variance-type analyses were conducted to examine the influencing variables of subgroup membership and to examine differences among subgroups in patient outcome. RESULTS The high-pain/high-fatigue (HPHF) and low-pain/low-fatigue subgroups were found at both time points. The low-pain/high-fatigue subgroup was present only in the first chemotherapy cycle. Pain and fatigue levels significantly differentiated subgroups at each time point (all P<0.05). Across the two time points, experiencing higher depressed mood increased the risk to be in the HPHF subgroup (all P<0.01). The HPHF subgroup had the most serious limitations in activities (all P<0.01). CONCLUSION This study confirmed the existence of a unique symptom experience of pain and fatigue. This pattern should be acknowledged for symptom assessment and management.
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Affiliation(s)
- Hee-Ju Kim
- College of Nursing, Catholic University of Korea, Seoul, Republic of Korea.
| | - Patrick S Malone
- Department of Psychology, University of South Carolina, Columbia, South Carolina, USA
| | - Andrea M Barsevick
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Contribution of symptom clusters to multiple sclerosis consequences. Qual Life Res 2014; 24:617-29. [DOI: 10.1007/s11136-014-0804-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2014] [Indexed: 10/24/2022]
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McPherson CJ, Hadjistavropoulos T, Devereaux A, Lobchuk MM. A qualitative investigation of the roles and perspectives of older patients with advanced cancer and their family caregivers in managing pain in the home. BMC Palliat Care 2014; 13:39. [PMID: 25140119 PMCID: PMC4137110 DOI: 10.1186/1472-684x-13-39] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 07/31/2014] [Indexed: 12/04/2022] Open
Abstract
Background Pain in advanced cancer is complex and multifaceted. In older patients comorbidities and age-related functional decline add to the difficulties in managing cancer pain. The current emphasis on care in the community, and preference by patients with life-limiting disease to receive care in the home, has meant that patients and their family caregivers have become increasingly responsible for the day-to-day management of cancer pain. An appreciation of patients’ and caregivers’ roles and perspectives managing pain is, therefore, fundamental to addressing cancer pain in this setting. Consequently, we sought to explore and describe their perspectives and roles. Methods A qualitative descriptive approach was used. Semi-structured interviews were conducted with a purposeful sample of patient- family caregiver dyads. Participants included 18 patients aged 65 years and over, with advanced cancer, receiving palliative care at home, and 15 family caregivers. The interview data were analysed using thematic analyses. Strategies were used to establish rigour. Results Two main themes were identified. The first theme, "Communicating the pain", represented pain assessment and incorporated four subthemes in which participants described: their roles in pain assessment, the identification and expression of pain, and the communication of pain between patients and caregivers. The second theme, "Finding a solution", comprised of four subthemes that reflected participants’ roles and approaches in controlling pain; as well as their beliefs about cancer pain control, experience with side effects, and perspectives on the goals of treatment. Conclusions The findings support other studies in identifying knowledge and attitudinal barriers to pain control; while adding to the literature by highlighting practical and relational barriers faced by older patients and their family caregivers. Health care professionals can do much to address the barriers identified by: correcting misconceptions regarding cancer pain, facilitating the communication of pain within dyads, and ensuring that patients and family caregivers have the knowledge, skills, and ability to assess and implement pain treatment strategies. This support needs to be individually tailored to meet the ongoing needs of both members of the dyad so that the shared goals of pain management are accomplished.
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Affiliation(s)
- Christine J McPherson
- School of Nursing, Faculty of Health Sciences, University of Ottawa, 451, Smyth Road, Ottawa, Ontario K1H 8M5, Canada
| | | | - Alana Devereaux
- School of Nursing, Faculty of Health Sciences, University of Ottawa, 451, Smyth Road, Ottawa, Ontario K1H 8M5, Canada
| | - Michelle M Lobchuk
- Faculty of Nursing, University of Manitoba, Winnipeg, Manitoba R3T 2N2, Canada
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Hoffman AJ, Brintnall RA, von Eye A, Jones LW, Alderink G, Patzelt LH, Brown JK. Home-based exercise: promising rehabilitation for symptom relief, improved functional status and quality of life for post-surgical lung cancer patients. J Thorac Dis 2014; 6:632-40. [PMID: 24976984 DOI: 10.3978/j.issn.2072-1439.2014.06.08] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 05/13/2014] [Indexed: 11/14/2022]
Abstract
BACKGROUND Post-thoracotomy non-small cell lung cancer (NSCLC) patients report cancer-related fatigue (CRF) as a severe symptom that may increase the occurrence and severity of other symptoms while decreasing functional status and quality of life (QOL). The aim of this pilot study was to describe the effects of a home-based rehabilitative exercise intervention on CRF, other symptoms, functional status, and QOL for post-surgical NSCLC patients starting within days after hospital discharge. METHODS Seven post-thoracotomy NSCLC patients completed the Brief Fatigue Inventory (BFI) measuring CRF severity, and the M.D. Anderson Symptom Inventory measuring symptom severity at pre- and post-surgery, and at the end of each week of the six-week intervention. Additionally, the Medical Outcomes Short-Form-36 measuring physical and mental functional status; and the Quality of Life Index (QLI) measuring QOL were completed pre- and post-surgery, after week 3, and at the end of the intervention (week 6). RESULTS Participants had a mean age of 65 years, a mean of 6 co-morbid conditions, and initiated the intervention within 4 days after hospital discharge. Participants' CRF severity scores were reduced to mild levels while the mean number of symptoms decreased from 10.4 post-surgery to 7.0 at week 6 with lower levels of severity and interference. Likewise, participants' post-intervention functional status and QOL improved to near or above pre-surgical levels. CONCLUSIONS The exercise intervention for post-surgical NSCLC patients showed promising preliminary efficacy in improving CRF, other symptom severity, functional status, and QOL. Further testing via a two-arm randomized controlled trial is being conducted.
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Affiliation(s)
- Amy J Hoffman
- 1 College of Nursing, Michigan State University, East Lansing, Michigan, USA ; 2 Kirkhof College of Nursing, Grand Valley State University, Grand Rapids, Michigan, USA ; 3 Psychology Department, Michigan State University, East Lansing, Michigan, USA ; 4 Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York, USA ; 5 Frederik Meijer Honors College, Grand Valley State University, Grand Rapids, Michigan, USA ; 6 West Michigan Cardiothoracic Surgeons, Grand Rapids, Michigan and College of Human Medicine, Michigan State University, East Lansing, Michigan, USA ; 7 School of Nursing, University at Buffalo, the State University of New York, Buffalo, New York, USA
| | - Ruth Ann Brintnall
- 1 College of Nursing, Michigan State University, East Lansing, Michigan, USA ; 2 Kirkhof College of Nursing, Grand Valley State University, Grand Rapids, Michigan, USA ; 3 Psychology Department, Michigan State University, East Lansing, Michigan, USA ; 4 Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York, USA ; 5 Frederik Meijer Honors College, Grand Valley State University, Grand Rapids, Michigan, USA ; 6 West Michigan Cardiothoracic Surgeons, Grand Rapids, Michigan and College of Human Medicine, Michigan State University, East Lansing, Michigan, USA ; 7 School of Nursing, University at Buffalo, the State University of New York, Buffalo, New York, USA
| | - Alexander von Eye
- 1 College of Nursing, Michigan State University, East Lansing, Michigan, USA ; 2 Kirkhof College of Nursing, Grand Valley State University, Grand Rapids, Michigan, USA ; 3 Psychology Department, Michigan State University, East Lansing, Michigan, USA ; 4 Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York, USA ; 5 Frederik Meijer Honors College, Grand Valley State University, Grand Rapids, Michigan, USA ; 6 West Michigan Cardiothoracic Surgeons, Grand Rapids, Michigan and College of Human Medicine, Michigan State University, East Lansing, Michigan, USA ; 7 School of Nursing, University at Buffalo, the State University of New York, Buffalo, New York, USA
| | - Lee W Jones
- 1 College of Nursing, Michigan State University, East Lansing, Michigan, USA ; 2 Kirkhof College of Nursing, Grand Valley State University, Grand Rapids, Michigan, USA ; 3 Psychology Department, Michigan State University, East Lansing, Michigan, USA ; 4 Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York, USA ; 5 Frederik Meijer Honors College, Grand Valley State University, Grand Rapids, Michigan, USA ; 6 West Michigan Cardiothoracic Surgeons, Grand Rapids, Michigan and College of Human Medicine, Michigan State University, East Lansing, Michigan, USA ; 7 School of Nursing, University at Buffalo, the State University of New York, Buffalo, New York, USA
| | - Gordon Alderink
- 1 College of Nursing, Michigan State University, East Lansing, Michigan, USA ; 2 Kirkhof College of Nursing, Grand Valley State University, Grand Rapids, Michigan, USA ; 3 Psychology Department, Michigan State University, East Lansing, Michigan, USA ; 4 Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York, USA ; 5 Frederik Meijer Honors College, Grand Valley State University, Grand Rapids, Michigan, USA ; 6 West Michigan Cardiothoracic Surgeons, Grand Rapids, Michigan and College of Human Medicine, Michigan State University, East Lansing, Michigan, USA ; 7 School of Nursing, University at Buffalo, the State University of New York, Buffalo, New York, USA
| | - Lawrence H Patzelt
- 1 College of Nursing, Michigan State University, East Lansing, Michigan, USA ; 2 Kirkhof College of Nursing, Grand Valley State University, Grand Rapids, Michigan, USA ; 3 Psychology Department, Michigan State University, East Lansing, Michigan, USA ; 4 Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York, USA ; 5 Frederik Meijer Honors College, Grand Valley State University, Grand Rapids, Michigan, USA ; 6 West Michigan Cardiothoracic Surgeons, Grand Rapids, Michigan and College of Human Medicine, Michigan State University, East Lansing, Michigan, USA ; 7 School of Nursing, University at Buffalo, the State University of New York, Buffalo, New York, USA
| | - Jean K Brown
- 1 College of Nursing, Michigan State University, East Lansing, Michigan, USA ; 2 Kirkhof College of Nursing, Grand Valley State University, Grand Rapids, Michigan, USA ; 3 Psychology Department, Michigan State University, East Lansing, Michigan, USA ; 4 Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York, USA ; 5 Frederik Meijer Honors College, Grand Valley State University, Grand Rapids, Michigan, USA ; 6 West Michigan Cardiothoracic Surgeons, Grand Rapids, Michigan and College of Human Medicine, Michigan State University, East Lansing, Michigan, USA ; 7 School of Nursing, University at Buffalo, the State University of New York, Buffalo, New York, USA
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Abstract
BACKGROUND Symptom distress remains a significant health problem among older adults with cancer following surgery. Understanding factors influencing older adults' symptom distress may lead to early identification and interventions, decreasing morbidity and improving outcomes. OBJECTIVE We conducted this study to identify factors associated with symptom distress following surgery among 326 community-residing patients 65 years or older with a diagnosis of thoracic, digestive, gynecologic, and genitourinary cancers. METHODS This secondary analysis used combined subsets of data from 5 nurse-directed intervention clinical trials targeting patients after surgery at academic cancer centers in northwest and northeastern United States. Symptom distress was assessed by the Symptom Distress Scale at baseline and at 3 and 6 months. RESULTS A multivariable analysis, using generalized estimating equations, showed that symptom distress was significantly less at 3 and 6 months (3 months: P < .001, 6 months: P = .002) than at baseline while controlling for demographic, biologic, psychological, treatment, and function covariates. Thoracic cancer, comorbidities, worse mental health, and decreased function were, on average, associated with increased symptom distress (all P < .05). Participants 75 years or older reported increased symptom distress over time compared with those aged 65 to 69 years (P < .05). CONCLUSIONS Age, type of cancer, comorbidities, mental health, and function may influence older adults' symptom distress following cancer surgery. IMPLICATIONS FOR PRACTICE Older adults generally experience decreasing symptom distress after thoracic, abdominal, or pelvic cancer surgery. Symptom management over time for those with thoracic cancer, comorbidities, those with worse mental health, those with decreased function, and those 75 years or older may prevent morbidity and improve outcomes of older adults following surgery.
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Hoffman AJ, Brintnall RA, von Eye A, Cooper J, Brown JK. The voice of postsurgical lung cancer patients regarding supportive care needs. LUNG CANCER-TARGETS AND THERAPY 2014; 5:21-31. [PMID: 28210139 PMCID: PMC5217509 DOI: 10.2147/lctt.s59703] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Individuals with lung cancer present with multiple comorbid conditions and complex treatment plans. They are frequently vulnerable during critical transitions in the cancer survivorship trajectory. Limited research exists on the postsurgical non-small-cell lung cancer (NSCLC) population, relative to unmet supportive care needs. However, what is known is that the lung cancer population reports significantly more unmet supportive care needs than other cancer populations. The purpose of this study was to identify the postsurgical NSCLC patients' unmet supportive care needs during transition from hospital to home and through recovery after participating in a 16-week exercise intervention. MATERIALS AND METHODS Participants were 53-73 years of age with NSCLC (stage Ib-IIIa) and participated in a 16-week light-intensity exercise program after hospital discharge. For this study, participants were interviewed 12-18 months post-thoracotomy. A qualitative design was used, incorporating a semistructured guide with open-ended questions to support discussion regarding recovery experiences through 16 weeks after transitioning from hospital to home. The interview was transcribed verbatim, and data were analyzed using content analysis. Content themes were independently coded by investigators and later combined into a single report verified through participant verification of the report. RESULTS Participants reviewed and agreed with the focus group report. Dominant themes included: 1) unpreparedness for post-thoracotomy recovery; 2) significant unmet needs upon hospital discharge and throughout the cancer survivorship trajectory; 3) unexpected symptom burden after initial month of recovery; 4) the quality of information given when pain and fatigue were troublesome during recovery; and 5) the effectiveness of exercise during the recovery process. CONCLUSION Understanding the changing needs of this population during these transitions will assist in the development of targeted supportive care interventions, to preempt negative outcomes associated with breakdowns in care during critical transition periods of the cancer survivorship trajectory.
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Affiliation(s)
- Amy J Hoffman
- College of Nursing, Michigan State University, East Lansing, MI, USA
| | - Ruth Ann Brintnall
- Kirkhof College of Nursing, Grand Valley State University, Grand Rapids, MI, USA
| | - Alexander von Eye
- Psychology Department, Michigan State University, East Lansing, MI, USA
| | - Julie Cooper
- Kirkhof College of Nursing, Grand Valley State University, Grand Rapids, MI, USA
| | - Jean K Brown
- School of Nursing, State University of New York at Buffalo, Buffalo, NY, USA
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